Caribbean Exploratory (NCMHD) Research

Center UpdateGloria B. Callwood, PhD, RN

Presented at Caribbean Exploratory Research Center

2nd ANNUAL HEALTH DISPARITIES INSTITUTEOctober 15, 2009

ObjectivesThis 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. Croix Campus

St. Thomas Campus

Who are Virgin Islands Residents?

The Virgin Islands is a blended multiculturalSociety with a direct affect on the cultureand 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 deathCardiovascular DiseaseCancer

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 32.7% (BRFSS, 2006)

Large immigrant population 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 Islands1. Disease and disease management2. Financial concerns3. 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 YouQuestions?

Supported by a grant from NIH NCMH-HD #1P20MD002286-03