The Covid-19 pandemic, accompanied by racial justice movements and unrest, has thrown health disparities into the spotlight. Our discussions with cardiovascular (CV) leaders this past year demonstrated that patients are negatively impacted by unaddressed non-clinical factors like food insecurity, lack of transportation, and economic instability. Achieving health equity needs to be top-of-mind for service line leaders as we continue to battle the pandemic, with the hopes of recovering and rebuilding from it.
While Covid-19 has increased attention on social determinants of health, this isn't a new priority for all institutions. Many community-based organizations have long taken the lead in supporting local populations' non-clinical needs, such as by providing language services or improving access to medications. We sought insight for service line leaders on eliminating health disparities in CV care from two non-hospital organizations.
- Asian Health Coalition (AHC) aims to eliminate health disparities among communities of color in the Chicago area. They have a cardiovascular health curriculum program called Cardiovascular Awareness Recognizing Diet and Integration of Exercise Options (CARDIO). CARDIO was initially implemented for the South Asian community and is now being expanded to the local Chinese population.
- Westminster Free Clinic (WFC) is a volunteer-based health care provider in Ventura County, California. Their "Corazones Sanos" (Healthy Hearts) initiative strives to improve the cardiovascular health outcomes of uninsured, low-income Latinos. The program provides a range of culturally appropriate services, including physical activity classes, labels indicating heart-healthy foods at local Latino markets, and stress management sessions.
Here are the top four takeaways from our conversations, with example strategies from each organization.
1. Build trust with the population of interest.
Being transparent and sharing information in easily accessible ways helps promote open communication, respect, and trust. Organizations can use this foundation to foster meaningful participant engagement.
- AHC partners with other community organizations that are well-known and respected by the target population. In CARDIO's first year, AHC collaborated with a health care site that employed many South Asian clinicians. These care providers could identify with the South Asian population on a cultural level and share important CARDIO information accordingly.
- WFC developed a scribe training program for college students in the community to learn about health care. During WFC's two-year training program, participants gain skills and knowledge that empower them in their future careers and their communities. The program also allows community members to see the positive impact of WFC's initiatives, such as Corazones Sanos, and learn about how they can participate in WFC's programs.
2. Be flexible with any community programming you offer.
Initiatives tackling social determinants of health need to consider the unique preferences and capabilities of the community. If there are elements of the program that don't meet the target population's specific needs, organizations need to adapt in response to participant feedback.
- AHC designed CARDIO for South Asian locals by modifying CDC's evidence-based cardiovascular curriculum. AHC used constructive criticism from the community to ensure that CARDIO's educational materials fit with the language and communication norms of the South Asian population.
- In working with their local Latino population, WFC realized that literacy was a challenge for some participants of Corazones Sanos. To make the program more inclusive, WFC designed all activities, such as end-of-session evaluations, so that people of all literacy levels can proudly participate without fear of shame. Additionally, to ensure access and convenience, no class offerings are rigidly structured or require a weekly commitment.
3. Rely on team members with diverse backgrounds, representative of the target population, to design culturally appropriate interventions.
Staff members with different backgrounds can infuse their knowledge and first-hand understanding of a culture into community projects. This ensures that resources are applicable to the daily lives of participants.
- AHC project team members who are Chinese American used their personal experience to adjust the CARDIO curriculum for the Chinese community. For instance, AHC staff edited the healthy food item recommendations to fit homemade Chinese cuisine.
- WFC hired a Spanish-speaking immigrant behavioral health clinician who can help participants feel comfortable and at ease.
4. Collect quantitative and qualitative data to show impact.
Gathering data is important for receiving initial grant funding and guaranteeing the continuation of an intervention. Having participant testimony and clinical outcomes can show areas of success and improvement for the program.
- Since Covid-19 social distancing mandates were put in place, AHC participants have been self-reporting data virtually on what they've learned about positive cardiovascular health behaviors as well as what changes they've seen in their hip and waist circumferences. These participants will also be asked to provide data three and six months after completing CARDIO.
- WFC tracks behavioral improvements, weight, BMI, blood pressure, and lab measurements for all participants up to five years after Corazones Sanos.
AHC and WFC have prioritized advancing health outcomes in underserved populations. It's now CV program leaders' turn to follow in the footsteps of community-based organizations and eliminate health disparities among their patients.
How is your organization addressing health inequity among cardiovascular patients? Share your story with us by emailing Jinia Sarkar (email@example.com).