文章基本信息

标题：A Participatory Action Research Pilot Study of Urban Health Disparities Using Rapid Assessment Response and Evaluation
本地全文：下载
作者：David Richard Brown ; Agueda Hernández ; Gilbert Saint-Jean 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：1
页码：28-38
DOI：10.2105/AJPH.2006.091363
语种：English
出版社：American Public Health Association
摘要：Healthy People 2010 made it a priority to eliminate health disparities. We used a rapid assessment response and evaluation (RARE) to launch a program of participatory action research focused on health disparities in an urban, disadvantaged Black community serviced by a major south Florida health center. We formed partnerships with community members, identified local health disparities, and guided interventions targeting health disparities. We describe the RARE structure used to triangulate data sources and guide intervention plans as well as findings and conclusions drawn from scientific literature and epidemiological, historic, planning, clinical, and ethnographic data. Disenfranchisement and socioeconomic deprivation emerged as the principal determinants of local health disparities and the most appropriate targets for intervention. HEALTHY PEOPLE 2010 established “eliminating health disparities” 1 as a public health priority, proposing that social determinants such as poverty, violence, and poor housing may negatively affect health outcomes. Health gradients have been demonstrated for income, 2 education, 3 and socioeconomic deprivation 4 ; these, however, do not fully explain racial disparities. 5 ^– 10 For hundreds of years, Blacks were systematically denied full citizenship rights in the United States. 11 Since the end of legalized segregation, they continue to be marginalized in our society, 12 ^– 31 with unequal access to education, 22 jobs, 23 ^– 24 and housing 25 ^– 26 and through myriad forms of racism. 26 ^– 28 Miami’s historically Black neighborhood of Overtown has one of the highest rates of poverty 29 and mortality from chronic disease in the county (G. Zhang, PhD, Miami–Dade County Health Department, written communication, 2006). 29 Miami’s early Black residents (mostly immigrants from the Bahamas and other parts of the West Indies, as well as parts of the southern United States) were restricted to living in “Colored Town,” 30 ^(p62) later called “Overtown” 30 ^(p151) because it was just “over” the downtown district. During its prosperous heyday (1930s through the 1950s), visiting Black entertainers, not allowed to stay overnight in Miami Beach after their performances, stayed in Overtown. Overtown came to be known as “Little Broadway” 30 ^(p142) and grew into a commercial, professional, and cultural center, home to physicians and other leaders of the Black community. In the mid-1960s, business and political leaders of the City of Miami routed the Interstate 95–395 intersection through the center of Overtown (M. Dluhy, P. Cattan, K. Revell, J. Strube, and S. Wong, unpublished report, 1998). 30 ^, 31 Thousands of Over-town residents were evicted, leaving public housing and multifamily zoning where single-family dwellings had once existed. 30 ^, 32 Today, Overtown is an English-speaking, predominantly Black, distressed urban enclave surrounded by Hispanic communities and the downtown business and hospital districts, with contentious redevelopment and gentrification projects surrounding and rapidly encroaching into the community. 33 Two state senators sponsored legislation funding construction of 2 clinics in central Miami–Dade County—the Jefferson Reaves, Sr Health Center (JRSHC) and the Peñalver Clinic—“to bring affordable health care to their respective communities” (B. Loyd, administrator, JRSHC, written communication, April 10, 2007). A partnership between the Miami–Dade County Health Department, a state agency, and the county-operated Jackson Health System allowed the JRSHC to open in 1998 as a county-operated primary care center with the mission of serving Overtown. 34 A community clinic operated by the Family Medicine Department of the University of Miami Miller School of Medicine merged its staff into the JRSHC, which then became the primary training site for the Jackson Memorial Hospital family medicine residency program administered by the university. Two JRSHC interventions targeted health disparities. Beginning in September 2004, a Health Resources and Services Administration (HRSA) Title VII 35 primary care training grant funded a multifaceted research project to develop a curriculum for cultural competence (i.e., the ability to function effectively in cross-cultural settings), develop tools for the evaluation of cultural competence, and incorporate service-learning projects based on principles of community-oriented primary care. 36 Concurrently, a gift from the United Health Foundation targeted improved disease management, multidisciplinary care, and careful attention to the processes of care. 37 This study was initially conceived as a multimethod community health needs assessment for the HRSA project. Because there was another project targeting disparities starting concurrently, and given our local expertise, we elected to implement a rapid assessment 38 ^– 40 targeting health disparities. Rapid assessment procedures include (1) formation of a multidisciplinary research team including a member indigenous to the cultural group of interest, (2) development of materials to train indigenous team members, (3) use of several data collection methods to verify information through triangulation, (4) iterative data collection and analysis to facilitate continuous adjustment, and (5) completion of the project quickly, usually in four to six weeks. 38 ^(p375)