J. Racial and Ethnic Health Disparities DOI 10.1007/s40615-016-0221-4
Jazzin’ Healthy: Interdisciplinary Health Outreach Events Focused on Disease Prevention and Health Promotion Diana Isaacs 1 & Angela C. Riley 2 & Lalita Prasad-Reddy 1 & Rebecca Castner 1 & Heather Fields 1 & Deborah Harper-Brown 1 & Sabah Hussein 1 & Charisse L. Johnson 1 & Traiana Mangum 1 & Sneha Srivastava 1
Received: 25 August 2015 / Revised: 9 March 2016 / Accepted: 11 March 2016 # W. Montague Cobb-NMA Health Institute 2016
Abstract Objectives Health-related disparities are a significant public health concern. In conjunction with a university concert series, healthcare professionals and students provided education, clinical services, and preventive care using an interdisciplinary approach to a primarily African American cohort. The objective was to assess cardiovascular risk factors and readiness to change health-related behaviors. Methods Six outreach events were conducted over 3 years by an interdisciplinary team including pharmacy, medicine, nursing, nutrition, occupational therapy, public health, optometry, and health information technology. Clinical services, such as health screenings for glucose, blood pressure, cholesterol, and body fat along with counseling on the results and smoking cessation behavioral counseling, were provided. Education initiatives addressed bone health, heart disease, HIV risk, nutrition, and access to physician care. Preventative care included vaccinations and eye exams. Results There were 285 participants that were predominantly African American (95.8 %), female (71.5 %), and age within 55–64 years (45.1 %). Hypertension (50.8 %) and obesity (65.1 %) were the most common cardiovascular risk factors. Of those advised to make health behavior changes, 76.4 % reported they planned to make changes within 1 month.
* Diana Isaacs
[email protected]
1
College of Pharmacy, Chicago State University, 9501 S. King Drive/ Douglas Hall 3093, Chicago, IL 60628, USA
2
School of Pharmacy and Pharmaceutical Sciences, Binghamton University, P.O. Box 6000, Binghamton, NY 13902-6000, USA
Conclusion These interdisciplinary outreach events provided health information and access to care in a novel setting and led to a high rate of planned health behavior changes. Keywords African Americans . Cardiovascular diseases . Medically underserved areas . Health promotion . Interdisciplinary communication . Healthcare disparities
Introduction Health fairs and community health outreach events are methods to increase patients’ understanding of health status, encourage follow-up, and maintain health improvement strategies [1]. The American Heart Association reports that certain ethnic groups within the USA, such as African Americans and Hispanics, have higher risk for cardiovascular disease and higher prevalence of cardiovascular risk factors including hypertension, obesity, and diabetes when compared to Caucasians [2]. These populations are often less likely to be appropriately treated, leading to suboptimal outcomes. Furthermore, stroke awareness is much higher in Caucasians compared to high-risk populations [2]. Limitations to access and quality of care have been identified as key contributing factors to the formation of these health disparities [3]. Even with the implementation of the Affordable Care Act in the USA, access to care has improved for African Americans and Hispanics but still lags behind Caucasians [4]. Such limitations are not unique to the USA in their impact on health outcomes. The World Health Organization (WHO) identifies structural determinants, defined as those social determinants of health that cause stratification within a society, as the root cause of inequities in health across the globe. As a
J. Racial and Ethnic Health Disparities
structural determinant, discrimination based on ethnicity creates a socioeconomic hierarchy, ultimately affecting access to resources, cardiovascular disease, and the health system itself [5]. Health fairs and community health outreach events may be used to minimize health disparities through the use of screening services and encouragement for follow-up care [6]. It has been reported that health fairs increase patient understanding of disease-specific information following screening and counseling, which is important to improving overall health [7]. Research has also shown the importance of multidirectional communication with interdisciplinary collaboration to allow for the utmost cooperation and trust among everyone involved in the care of a patient [8]. There is widely available literature related to community screening and cardiovascular risk education targeting at-risk populations. However, the number of articles that include interprofessional or interdisciplinary teams within this target population is much more limited. Chicago State University (CSU), which includes a College of Pharmacy (COP), a College of Health Sciences, and numerous other undergraduate and graduate programs, is a statefunded institution located on the south side of Chicago. CSU is committed to service and community development with a focus on its surrounding community, which is predominantly African American. The CSU mission and vision support identifying the disparate nature of access to health care among underserved and at-risk populations and leading interventions to minimize this gap. One way we work toward achievement of this mission and vision is through the BJazzin’ Healthy^ outreach events. The purpose of these events is to provide effectively tailored education, clinical services, and preventive care to underserved populations through innovative health outreach events. The primary objective of this cross-sectional study is to assess individual cardiovascular risk factors and their prevalence in the community. The secondary objectives are to 1. Assess participants’ readiness to change health-related behaviors through the use of collaborative health screening and education, and 2. Identify factors preventing readiness to change healthrelated behaviors. It is hypothesized that these health outreach events will increase participants’ awareness of cardiovascular risk factors and increase readiness to change health-related behaviors.
Methods This study was approved by the Institutional Review Board at CSU. During September of 2012, 2013, and 2014, six
outreach events were conducted on the CSU campus at three annual public BJazz in the Grazz^ concert series. These outreach events, named BJazzin’ Healthy,^ were located adjacent to the concert stage. The ultimate goal was to promote healthy living behaviors among attendees from diverse backgrounds—specifically African American and Hispanic populations—at a heavily attended social event. Information about the health outreach events was posted on the CSU website, in surrounding businesses, and sent to community partners via email. Recruitment was also done through direct advertising via an announcement about the outreach event from the performance stage before the start of the concert and during intermission. Additionally, students recruited participants from the concert audience. Individuals signed a consent form to be included in the study, and had the option to participate in the outreach activities without joining the study. To further encourage participation, individuals were given a reusable bag and entered into a raffle after completing any component of the health outreach event and consenting to be included in the study. Participants were offered clinical services including health screenings for glucose, blood pressure, cholesterol, and body fat along with counseling on the results. Vaccinations, eye exams, and smoking cessation behavioral counseling were also provided. Each counseling session detailed the patients’ target goals of therapy and lifestyle modifications that could be incorporated to improve overall health. If a participant’s blood pressure, cholesterol levels, or glucose levels were outside the target goals or ranges, then the participant was given a one-on-one counseling session. Each targeted one-on-one session included a brief discussion of probable causes of the testing results, and each participant received literature created by the American Heart Association to support the recommended modifications. Health fair participants were also provided education regarding bone health, heart disease, HIV risk, nutrition, and access to physician care. All services were delivered by interprofessional teams comprised of healthcare practitioners and students from a variety of disciplines, including pharmacy, medicine, nursing, nutrition, occupational therapy, public health, optometry, and health information technology. Stations are shown in Fig. 1. Health screening data were collected for blood pressure, total cholesterol, glucose, and body fat percentage, and used to assess cardiovascular risk factors. In the first year, 2012, participants completed a nine-item survey related to study objectives and demographic data. Demographic information collected included age, ethnicity, sex, and educational level. The first five items were adapted from a previously validated questionnaire [9]. The remaining four items were created to obtain data directly related to study objectives, including likelihood of making behavioral changes based on knowledge gained from the event. During the following year, 2013, the BJazzin’ Healthy^ committee restructured the outreach events
J. Racial and Ethnic Health Disparities Fig. 1 Health education and screenings: (a) fall risk/bone health information, (b) influenza vaccines, (c) tobacco cessation information/referrals, (d) American Heart Association My Life Check (2014), (e) medical referral/Affordable Care Act information, ( f ) HIV/AIDS information, (g) cholesterol screening, (h) blood glucose screening, (i) body fat analysis, (j) blood pressure screening, (k) coronary heart disease risk assessment and awareness, (l) vision screening
based on recognition of the void in data available regarding collaborative, interdisciplinary outreach. As such, the focus shifted to increasing interprofessional collaboration and expanding community partners including local health systems and pharmacies. Only health screening information was collected, not survey data. In 2014, the committee chose to modify the BJazzin’ Healthy^ survey to obtain more data on our specific populations’ readiness for behavioral change, especially because a large component of the health outreach centered on lifestyle counseling and health promotion. Surveys from the previous years had only collected data on health knowledge and intent for healthcare follow-up after the event, but the committee felt that given the nature of the high-risk population, a deeper assessment of participants’ readiness to adopt healthy behaviors was warranted. The initial 2012 survey was extended to a total of 14 items, allowing for expansion of data collection regarding participants’ readiness to incorporate healthy lifestyle changes and plans to obtain recommended healthcare follow-up. Participants were surveyed on self-perception of their health status, factors that may motivate behavioral change, factors that may prevent potential behavioral change, self-perceived readiness to make lifestyle changes, as well as a timeline of anticipated implementation of recommended lifestyle changes. Survey data was also expanded in an attempt to further identify possible links between current cardiovascular risk status and a variety of healthrelated habits and attitudes. A sample of the 2014 survey is in Fig. 2. All surveys utilized a combination of multiple-choice, Likert-scale, and open-ended items. Health screening data were recorded on duplicate forms and individual copies of results were given to each participant. After data collection, raw data were compiled and analysis was performed. Descriptive statistics were used to describe demographic
characteristics of the population, survey results, and factors associated with change.
Results Demographic and health screening data were similar for 2012 and 2014 and are included in Table 1. A total of 285 participants were included in this study over 3 years (2012, 2013, and 2014). Data obtained were specific to the methodology utilized each year as previously described, and results subject to the purview of each participant, as completion of all survey questions and/or screening stations were not required for participation. Using the 2012 and 2014 data, we determined the majority of participants were female (71.5 %), and most selfidentified as African American (95.8 %). The average age was 56.6 years. Of those who disclosed the highest level of education, most had completed at least some college education (some college or higher [88.9 %]). Execution of the primary objective of this study was observed via the number of subjects that was notified of certain cardiovascular risk factors or abnormal test results through health screening data. The prevalence of select cardiovascular risk factors—age, high cholesterol, high blood pressure, high glucose, obesity, and tobacco use—is recorded in Table 2. Most participants reported prior diagnosis of, or examination at the event suggested, at least one modifiable cardiovascular risk factor with highest prevalence being hypertension (50.8 %) and obesity (67.8 %). Further analysis was performed using 2012 and 2014 data to determine the extent to which participants who were previously aware of their personal cardiovascular risk factors were effectively controlled, as well as whether the proportion of those controlled with
J. Racial and Ethnic Health Disparities Fig. 2 Jazz in the Grazz participant survey
1. What is your age? ________ YEARS OLD 2. What is your sex (circle one)? MALE
FEMALE
3. Which one of these groups would you say best describes your race/ethnicity (circle one)? HISPANIC/LATINO
BLACK/AFRICAN AMERICAN
NONHISPANIC/CAUCASIAN
NATIVE HAWAIIAN OR PACIFIC ISLANDER
AMERICAN INDIAN OR ALASKA NATIVE
ASIAN
OTHER
4. What is the highest grade or year of school you completed? a. Never aended school or only aended kindergarten b. Elementary (Grades 1 through 8) c. Some high school (Grades 9 through 11) d. High school graduate (Grade 12 or GED)
e. Some college or technical school f. College graduate g. Post-graduate training
5. In general, compared to people your own age, how would you rate your health prior to today’s health fair? Excellent
Very good
Fair
Poor
Extremely poor
6. Have you ever been told by a doctor, nurse, or other health professional that you have or had any of the following (circle all that apply)? a. High blood pressure f. Diabetes b. High cholesterol g. Asthma, chronic obstrucve pulmonary disease (COPD), c. Heart aack or myocardial infarcon emphysema or chronic bronchis d. Angina or coronary heart disease h. I have never been told I have any of these condions e. Stroke 7. Have you been advised by a healthcare professional today to make any changes for good health? Yes No I was not advised 7a. If you were advised to make changes for good health, when do you plan to make changes for good health. a. Within the next week d. Within the next 12 months b. Within the next month e. I do not plan on making any of these changes c. Within the next 6 months 8.Have you been told by a health care professional today that you should follow- up on test result from today’s health fair with a physician or medical professional. Yes No I was not advised 8a. If you have been told by a health care professional today to follow-up on a test result from today’s health fair with a physician or medical professional, when do you plan to follow-up? a. Within the next week d. Within the next 12 months b. Within the next month e. I do not plan on making any of these changes c. Within the next 6 months
9. Has your parcipaon in today’s health fair movated you to change an unhealthy behavior (smoking, alcohol, exercise, nutrion)? Yes No I was not advised 9a. What unhealthy behavior are you planning on changing? ____________________ 9b. If you answered yes to the previous queson, how ready are you to make the changes discussed at today’s health fair? Extremely ready Ready Neutral Somewhat unready Unready 9c. If you answered no to queson 9, what factors prevent you from changing your unhealthy behaviors? (Circle all that apply) Financial limitaons
Time
Lack of interest
Stress
Other_____________
10. Which of the following do you feel you know more about aer parcipang in the health fair today (circle all that apply) Blood pressure Quing Smoking Bone health Cholesterol Diabetes Maintaining a healthy weight Personal health records I do not feel like I know more about any of these topics Vaccines 11. What was/were your favorite part or parts of the health fair today (circle all that apply)? a. Learning about effects of high blood pressure, being overweight, high cholesterol, high blood sugar and/or smoking on my health b. Learning what acons I can take to improve my health c. Talking to health care professionals in a relaxed seng d. Talking to more than one kind of health care professional (i.e. physician, nurse, pharmacist, occupaonal therapist) at the same health fair e. Other (please explain):______________________________________________________________ 12. Why did you parcipate in today’s health fair? a. Free health screenings b. Wanng to learn more about healthy living and disease prevenon c. Planning on aending Jazz in the Grazz d. Relaves/friends aending e. Free incenves 13. Would you like similar health fairs to be offered in the future? a. Yes b. No c. Don’t know/Prefer not to answer Quesons 1 -5 adapted from: Centers for Disease Control and Prevenon (CDC). Behavioral Risk Factor Surveillance System Survey Quesonnaire. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevenon, 2011.
J. Racial and Ethnic Health Disparities Table 1
Demographic data 2012 n(%)
2014 n(%)
Total n(%)
Age
N = 102
N = 71
N = 173
Mean/mode
57.4/59
55.3/56
56.6/57
18–24 25–34
1(1.0) 4(3.9)
0(0.0) 6(8.5)
1(0.6) 10(5.8)
35–44
4(3.9)
5(7.0)
9(5.2)
45–54 55–64
26(25.5) 45(44.1)
14(19.7) 33(46.5)
40(23.1) 78(45.1)
22(21.6) N = 97
13(18.3) N = 75
35(20.2) N = 172
68(70.1)
55(73.3)
123(71.5)
N = 95 91(95.8)
N = 72 69(95.8)
N = 167 160(95.8)
0(0.0) 2(2.1)
0(0.0) 0(0.0)
0(0.0) 2(1.2)
0(0.0) 2(2.1) N = 101
1(1.4) 2(2.8) N = 70
1(0.6) 4(2.4) N = 171
1(0.1) 9(8.9)
1(1.4) 8(11.4)
2(1.2) 17(9.9)
43(42.6) 48(47.5)
25(35.7) 36(51.4)
68(39.8) 84(49.1)
65+ Sex Female Race Black/African American White/Caucasian Asian Hispanic/Latino Other Highest grade of education Elementary or lower Some high school/high school graduate/GED Some college or technical school College graduate or higher
prior knowledge of the risk factors differed from those without a previous diagnosis (Table 2). Data regarding total cholesterol levels trended on average toward better control from 2012 to 2014, with 45.8 % of participants tested in 2012 having levels >200 mg/dL, based upon the borderline high category previously outlined in the Adult Treatment Panel (ATP) III cholesterol guidelines, whereas only 14.9 % of those tested in 2014 were found to have high levels. The prevalence of diagnosis of high cholesterol also decreased when comparing the 2012 and 2014 cohorts, but to a much lesser extent (45.8 % in 2012 vs. 36.2 % in 2014). Table 3 compares the prevalence of various cardiovascular risk factors that were assessed in our population with baseline estimates of the prevalence of those risk factors in the general population, as well as the target reduction rates per the Healthy People 2020 initiative [10]. General awareness of cardiovascular risk factors was assessed via the survey item, BWhich of the following do you feel you know more about after participating in the health fair today?^ A total of 152 participants (94.4 %) reported increased knowledge about at least one cardiovascular risk factor as a result of this event. By far, the most common was blood pressure (53.9 %), followed by diabetes (31.6 %). The secondary objectives, participants’ readiness to change health-related behaviors and factors preventing readiness to
change, were assessed via survey items asking if the participant was advised at the event to make changes, when the participant anticipated making those changes, and factors preventing readiness to make changes. There were also survey items regarding readiness to change to address general health, abnormal test results, and lifestyle changes. These results are recorded in Table 4. Only 24 (29.6 %) participants stated barriers to making changes, with the most common being time (45.8 %). Out of all participants who responded, 97.6 % would like to attend similar events in the future.
Discussion The BJazz in the Grazz^ concert series hosted by CSU is a unique venue to host the BJazzin’ Healthy^ outreach events and provide a number of health screenings, educational booths, and other health-related services to underserved and at-risk populations that may have difficulties accessing quality health care. These events also allow university students and faculty from a variety of health disciplines, as well as community partners, to collaborate in providing these services. The results of this study indicate the community outreach events successfully reached our target populations, the underserved and the population at risk for cardiovascular disease and resulting complications, as most participants were African American and had at least one cardiovascular risk factor. Survey responses demonstrate that most gained new knowledge, were prepared to change at least one health-related behavior, and would like similar events offered in the future. It was interesting to find that there was a trend toward a reduction in uncontrolled cholesterol—although we were unable to directly compare surveys from different years due to involvement of different cohort participants. Future analysis would be beneficial to determine what factors may contribute to the decrease within the community, possibly including education received by those who attended our events. Interprofessional education (IPE) has become wellrecognized as a method for strengthening collaborative practice and improving health outcomes. The WHO has released recommendations directed toward global policymakers to facilitate implementation of IPE [11]. The BJazzin’ Healthy^ outreach events provided an opportunity for interdisciplinary collaboration. Each station included a combination of students and healthcare professionals from multiple health disciplines. Collaborative activities prepare health profession students to work effectively with other members of the healthcare team and community health partners to tackle public health issues and reduce health disparities. Research has also shown the importance of multidirectional communication with interdisciplinary collaboration to allow for the utmost cooperation and trust among everyone involved [8]. Therefore, conducting
J. Racial and Ethnic Health Disparities Table 2
Select cardiovascular risk factors
Risk factor
2012 n(%)
2013 n(%)
2014 n(%)
Total n(%)
Agea, b Femaleb BP ≥ 140/90 BP ≥ 140/90 with prior HTN diagnosis
74(74.0) 68(70.1)
N/A N/A
50(71.4) 55(73.3)
124(72.9) 123(71.5)
54(57.4) 31(33.3)
28(34.6)
42(60.9) 21(35.6)
124(50.8) 52(34.2)
BP ≥ 140/90 without prior HTN diagnosis
23(24.7)
16(27.1)
39(25.7)
BP < 140/90 with prior HTN diagnosis TChol>200c TChol > 200 with prior HLD diagnosis TChol > 200 without prior HLD diagnosis
16(17.2) 11(45.8)
9(15.3) 7(14.9)
25(16.4) 35(30.2)
4(8.5) 3(6.4)
9(12.7) 9(12.7)
TChol < 200 with prior HLD diagnosis Obesityd Tobacco use
6(25.0) 31(68.9) 12(21.1)
13(27.7) 40(80.0) 8(26.7)
19(26.8) 99(65.1)e 23(18.1)
3(5.9) 2(3.9)
4(3.4)
17(37.8)
5(20.8) 6(25.0) e
28(49.1) 3(7.5)
Glucose > 200 Glucose > 200 with prior DM diagnosis
1(1.5)
Glucose > 200 without prior DM diagnosis Glucose < 200 with prior DM diagnosis
1(2.0) 7(13.7)
BP blood pressure, HTN hypertension, TChol total cholesterol, HLD hyperlipidemia a
Age: female ≥ 55, male ≥ 45
b
Percentages are reported based on only those subjects who indicated age and sex. Those who did not report age and sex were not included in percentage calculations
c
While TChol < 180 is considered optimal per the AHA,
