Identifying Opportunities for Collective Action Around Community Nutrition Programming Through Participatory Systems Science

Background Immigrant communities have higher nutrition-related health disparities, exacerbated by food insecurity during the COVID-19 pandemic. Objective To apply principles of group model building (GMB), a participatory systems science approach, to identify barriers and opportunities for collective impact around nutrition programming in immigrant communities in an urban environment during and after the pandemic. Study Design, Setting, Participants We convened four in-person sessions in November 2021 that drew from GMB practice with 10 community partners organized around their program domains/goals: community gardening;nutrition education;community-supported agriculture;and future planning for food-related programming. Participants were prompted to collaboratively identify programmatic goals, challenges, and potential mitigating actions. Measurable Outcome/Analysis We generated a causal loop diagram (CLD) – a visual representation of hypothesized causal relationships between variables and feedback structures within a system – for each program domain. CLDs were validated and refined with community stakeholder input. We then synthesized all four CLDs into one comprehensive model which were shared with all community stakeholders during a plenary discussion session, which aided in identifying opportunities for collective action. Results Multilevel barriers emerged, including ethnocentric food policies that center the diets and practices of White Americans thereby inhibiting culturally tailored food guidelines and funding for culturally appropriate nutrition education;the shortage of culturally tailored nutrition education in communities as a missed opportunity for fostering pride in immigrant food culture and sustainment of traditional food practices;and limited access to/procurement of traditional ethnic produce in food assistance programs serving disadvantaged immigrant communities, increasing the likelihood of food waste and worsening food insecurity. Conclusions Emergent themes coalesced around the need to embed cultural tailoring into all levels of the food system, which would require coordinated actions around food policy advocacy, collectively identifying funding for culturally tailored community education and gardening, and community-academic research to support these actions. Funding NIH

Chinese Americans' Use of Patient Portal Systems: Scoping Review.

BACKGROUND: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients. OBJECTIVE: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs. METHODS: The authors conducted a literature search using the PRISMA Protocol for Scoping Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR) for extracting articles published in major databases (MEDLINE, Embase, and PsycINFO) on patient portals and Chinese Americans. Authors independently reviewed the papers during initial screening and full-text review. The studies were analyzed and coded for the study method type, sample population, and main outcomes of interest. RESULTS: In total, 17 articles were selected for inclusion in the review. The included articles were heterogenous and varied in their study aims, methodologies, sample populations, and outcomes. Major findings identified from the articles include variable patterns of portal access and use among Chinese Americans compared to other racial or ethnic groups, with limited evidence on the specific barriers and facilitators for this group; a preference for cross-sectional quantitative tools such as patient surveys and electronic health record-based data over qualitative or other methodologies; and a pattern of aggregating Chinese American-related data into a larger Asian or Asian American designation. CONCLUSIONS: There is limited research evaluating the use patterns, experiences, and needs of Chinese Americans who access and use patient portal systems. Existing research is heterogeneous, largely cross-sectional, and does not disaggregate Chinese Americans from larger Asian demographics. Future research should be devoted to the specific portal use patterns, preferences, and needs of Chinese Americans to help ensure contextually appropriate and acceptable design and implementation of these digital health tools.

COVID-19 and Asian Americans: Reinforcing the Role of Community-Based Organizations in Providing Culturally and Linguistically Centered Care.

Introduction: Community-based organizations (CBOs) have provided critical resources during the pandemic, particularly for marginalized communities, and are trusted liaisons who connect socially and linguistically isolated community members, such as the highly diverse Asian American population, to care during public health emergencies. Stereotypes such as the model minority myth have permeated public perception of Asian Americans' health status and health care access needs, fueling widespread belief that Asian Americans do not experience health disparities, and mask the high rates of coronavirus disease 2019 (COVID-19) infection, hospitalization, and mortality among Asian Americans. The unequal burden of COVID-19 on Asian American communities has largely remained absent from the public health and national discourse, with exceptions such as community voices that have directed news media coverage and leading roles of CBOs in offering culturally adapted, in-language programming on COVID-19 infection prevention and control. Methods: CBOs and their staff are well-equipped with the cultural acuity, language capacity, and familiarity with local norms to improve structural gaps affecting health outcomes and support health care delivery. Results: We discuss the roles and responsibilities of CBOs in strengthening the health care workforce and expanding community-clinic linkages and provide two case studies illustrating the efforts of two community organizations serving Asian American and immigrant communities, who have been disproportionally affected by the COVID-19 pandemic. Discussion: CBOs are essential to supporting health service coordination and care delivery for structurally vulnerable populations, and are vital to sustaining the coordinated, multilevel public health response to improving community health. Conclusion: Bolstering the current infrastructure to support CBOs is necessary to facilitating immediate responses to serve community needs.

The Mutually Reinforcing Cycle Of Poor Data Quality And Racialized Stereotypes That Shapes Asian American Health.

The Asian American health narrative reflects a long history of structural racism in the US and the complex interplay of racialized history, immigrant patterns, and policies regarding Asians in the US. Yet owing to systematic issues in data collection including missing or misclassified data for Asian Americans and practices that lead to indiscriminate grouping of unlike individuals (for example, Chinese, Vietnamese, and Bangladeshi) together in data systems and pervasive stereotypes of Asian Americans, the drivers and experiences of health disparities experienced by these diverse groups remain unclear. The perpetual exclusion and misrepresentation of Asian American experiences in health research is exacerbated by three racialized stereotypes-the model minority, healthy immigrant effect, and perpetual foreigner-that fuel scientific and societal perceptions that Asian Americans do not experience health disparities. This codifies racist biases against the Asian American population in a mutually reinforcing cycle. In this article we describe the poor-quality data infrastructure and biases on the part of researchers and public health professionals, and we highlight examples from the health disparities literature. We provide recommendations on how to implement systems-level change and educational reform to infuse racial equity in future policy and practice for Asian American communities.

Social Media Use and Misinformation Among Asian Americans During COVID-19.

Social media has been crucial for seeking and communicating COVID-19 information. However, social media has also promulgated misinformation, which is particularly concerning among Asian Americans who may rely on in-language information and utilize social media platforms to connect to Asia-based networks. There is limited literature examining social media use for COVID-19 information and the subsequent impact of misinformation on health behaviors among Asian Americans. This perspective reviews recent research, news, and gray literature to examine the dissemination of COVID-19 misinformation on social media platforms to Chinese, Korean, Vietnamese, and South Asian Americans. We discuss the linkage of COVID-19 misinformation to health behaviors, with emphasis on COVID-19 vaccine misinformation and vaccine decision-making in Asian American communities. We then discuss community- and research-driven responses to investigate misinformation during the pandemic. Lastly, we propose recommendations to mitigate misinformation and address the COVID-19 infodemic among Asian Americans.

Impact of Adult Day Service Center Closures in the Time of COVID-19

Adult Day Service Centers (ADCs) are a form of community-based long-term care that address frail older adults’ health and social needs. Due to their congregate nature and participants’ compromised health, many ADCs have been forced to temporarily shutter during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Framework, we (1) explore methods employed by ADCs during the pandemic to meet participant/caregiver needs and (2) determine how/whether these methods have mitigated the negative effects of ADC closures on participants and their caregivers. Both virtual focus groups and one-on-one semi-structured qualitative interviews were conducted with ADC staff members (n=20) across the United States. Preliminary results showed precipitous declines in physical, cognitive, and mental health of participants, as well as increased caregiver strain, particularly among dementia caregivers. However, ADCs found creative solutions to care for participants despite restrictions, creating, in their words, “centers without walls.” Staff developed virtual programs (e.g. support groups, music and exercise therapy) and conducted “door-step” visits to support productive engagement and combat loneliness. Telehealth supported care coordination and identification of emergent clinical problems. Results suggest that despite innumerable COVID-19-related challenges, ADCs demonstrated resilience and creativity in managing participants’ needs, fostered a sense of purpose, and provided caregiver respite. Further research on the effectiveness of remote programming and advocacy for sustainable reimbursement by payers is needed to ensure that ADCs can continue to provide older adults and their families with meaningful support as the pandemic wears on.