Toward Sustaining Web-Based Senior Center Programming Accessibility With and for Older Adult Immigrants: Community-Based Participatory Research Cross-Sectional Study.

BACKGROUND: During the COVID-19 pandemic, many community-based organizations serving Asian Americans pivoted to provide web-based care and social services. Asian American community leaders in the United States Pacific Northwest, including Asian Health & Service Center expressed that there are older immigrant adults who experienced backlash from discrimination, fear, and anxiety owing in part to anti-Asian hate and isolation, including from infection precautions. Pivoting supported staying safe from COVID-19 transmission and anti-Asian hate crimes. OBJECTIVE: This study aims to examine the readiness of diverse groups of older Asian American immigrant adults (Chinese, Koreans, and Vietnamese) to use a web-based senior center, including technology access and telehealth use, and to identify the psychosocial health impacts that a web-based senior center could be positioned to meet. METHODS: A community-based participatory research approach was used to conduct a cross-sectional survey study in an Asian-based health and service center in 2022. We selected surveys from the National Institutes of Health-supported PhenX Toolkit. Analyses were performed using R software. RESULTS: There was an 88.2% (216/245) response rate. Overall, 39.8% (86/216) of participants were Chinese, 25% (54/216) were Korean, and 24.5% (53/216) were Vietnamese. There were significant group differences in mobile data plans (P=.0005). Most had an unlimited mobile data plan (38/86, 44% Chinese; 39/54, 72% Koreans; 25/53, 47% Vietnamese). Significant group differences existed regarding whether they started using a new electronic device to communicate with friends or family after the COVID-19 outbreak (P=.0005); most were Korean participants (31/54, 57%). For written text and audio or video apps, most Chinese participants used WeChat (65/85, 76%; 57/84, 68%, respectively), most Koreans used KakaoTalk (49/54, 91%; 49/54, 91%, respectively), and most Vietnamese used Facebook Messenger for written text (32/50, 64%) and Apple Face Time (33/50, 66%) or Facebook Messenger (31/50, 62%) for audio or video. Significant group differences existed regarding whether to try telehealth (P=.0005); most Vietnamese expressed that they would never consider it (41/53, 77%). Significant group differences existed regarding how well they were able to concentrate (χ22=44.7; P<.0001); Chinese participants reported a greater inability (median 5, IQR 4-6). With regard to difficulties in life experiences (χ22=51; P<.0001), the median was 6 (IQR 5-7) for the Vietnamese group. Significant group differences existed in having had a family/household member's salary, hours, and contracts reduced (P=.0005) and having had a family/household member or friend fallen physically ill (P=.0005)-most Vietnamese (15/53, 28%) and Korean participants (10/53, 19%). CONCLUSIONS: To build an efficacious, web-based senior center with web-based care and social service options, more older adults need access to the internet and education about using technology-enabled communication devices. Addressing the unique psychosocial impacts of the COVID-19 pandemic on each group could improve health equity. The strength of the participating older adults was observed and honored.

An Antiracism Community-Based Participatory Research With Organizations Serving Immigrant and Marginalized Communities, Including Asian Americans and Native Hawaiians/Pacific Islanders in the United States Pacific Northwest: Qualitative Description Study With Key Informants.

BACKGROUND: Asian American (AA) community leaders, Native Hawaiian/Pacific Islander (NH/PI) community leaders, and allies in the United States Pacific Northwest expressed concern that there are families and children from AA communities and NH/PI communities who experience and witness acts of xenophobia and racism. This can cause racial trauma. The long-time practice of aggregating AA and NH/PI data contributes to erasure and makes it challenging to advance health equity, such as allocating resources. According to AAPI Data's long-awaited report in June 2022, there are over 24 million AAs and 1.6 million NHs/PIs in the United States, growing by 40% and 30%, respectively, between 2010 and 2020. Philanthropic investments have not kept up with this substantive increase. The National Academies of Sciences, Engineering, and Medicine emphasized the need for effective partnerships to advance the health and well-being of individuals and communities in antiracism and system-level research. OBJECTIVE: The aim of this community-based participatory research qualitative description study was to identify perceptions and experiences regarding racial discrimination, race-based stress, and racial trauma; intergenerational healing and resiliency; and sharing the body with science from key informants of an academic and community partnership to inform antiracism coalition work. This partnership includes academic researchers and community leaders from community-based organizations and a health care organization serving immigrant and marginalized communities, including AAs and NHs/PIs in the United States Pacific Northwest. METHODS: In total, 10 key informants joined 1 of 2 participatory group discussions via videoconference for 2 hours in 2022. We used a semistructured and open-ended group interview guide. A qualitative participatory group-level assessment was conducted with the key informants and transcribed. Interpretations and meanings of the main points and the main themes were reflected upon, clarified, and verified with the key informants in real time. The field note-based data transcripts were manually coded using conventional content analysis. Reflexivity was used. RESULTS: There were 6 main themes: prejudice plus power in racism definition and working in solidarity to counter lateral oppression/false sense of security, microaggression as multilayers, "not assimilationist by nature" and responding differently to white superiority, intergenerational- and identity-related trauma, what is healing among People of Color and through a lens of resiliency and intergenerational connection and knowledge, and mistrust and fear in the research and health care systems surrounding intentions of the body. CONCLUSIONS: The themes highlight the importance of internal and intergenerational healing from racial trauma and the need for solidarity among communities of color to combat white supremacy and colonization. This work was foundational in an ongoing effort to dismantle racism and uplift the community voice through a cross-sector academic and community partnership to inform antiracism coalition work.

Perceptions, Beliefs, and Experiences of Asians and Micronesian Islanders on Family Health History Genetic Cancer Screening Community Outreach.

Cancer carries stigma, taboos, and shame including, for diverse communities, who can have difficulty understanding and communicating about family health history genetic cancer screening (GCS). The Oregon Health Authority ScreenWise Program reached out to our academic-community research team to explore Asians and Micronesian Islanders (MI) perceptions on public health education outreach on GCS due to having previously only worked with the Latinx community. The purpose of the qualitative description pilot study was to elicit perceptions, beliefs, experiences, and recommendations from Asian and MI community leaders and community members regarding family health history GCS outreach in communities. Twenty Asians (Chinese and Vietnamese) and Micronesian Islanders (Chuukese and Marshallese) were recruited from the US Pacific Northwest. Nineteen participants are immigrants with an average 21.4 and 18.5 years having lived in the USA, respectively. Individual in-depth interviews were conducted using a semi-structured, open-ended interview guide and analyzed using conventional content analysis. Three main transcultural themes were identified: (1) degree of knowing and understanding cancer screening versus family health history GCS, (2) needing culturally relevant outreach messaging on family health history GCS, and (3) communication and decision-making regarding discussing with family and health care providers about cancer screening and GCS. Culturally relevant messaging rather than generic messaging is needed for inclusive outreach. Healthcare providers are encouraged to assess a client's family health history routinely because Asian and MI clients may not understand the information requested, may be hesitant to offer, or unable to provide information about their personal or family history of cancer.

Cultural Narratives of Micronesian Islander Parent Leaders: Maternal and Children's Health, the School System, and the Role of Culture.

Background: In Oregon in the United States' Pacific Northwest, Native Hawaiians/Pacific Islanders including Micronesian Islanders (MI) substantially grew by 68%; however, research is sparse. This is often due to data aggregation as Asian and Pacific Islanders and community members' reluctance and wariness to participate in research due to a history of unethical research in the Pacific. The MI community experienced miscarriages, stillbirths, and intellectual and developmental disabilities. Organizational MI community leaders expressed a need to explore the voices of MI parent leaders (MIPLs). The purpose of the community-based participatory qualitative descriptive pilot study was to explore the perceptions and experiences of MIPLs with maternal and children's health, the school system, and the influence of culture. Methods: A trained MI community health worker recruited eight MIPLs from an urban area of the Pacific northwest in the United States. A group level assessment included illustrative storytelling and is a participant-driven qualitative method that guided data collection and analysis with real-time involvement with MIPL. The discussions lasted for 90 minutes. MIPL shared stories by writing and drawing pictures onto the flip chart papers, transcribed main points, and analyzed the data with researchers. Researchers recorded field notes of the interactions. Researchers debriefed with MIPL to assure trustworthiness and credibility of the findings. Findings: MIPL are Compact of Free Association citizens. Their age ranged from 26 to 42 years, have lived in the United States an average of 12.63 years, and most reported having less than $15,000 total household income before taxes. Four main themes were identified: MI cultural identity, English language and MI culture disharmony, zero or delayed prenatal care, and uncertainty for the future of MI children who have disabilities or developmentally delayed as they progress through the school system. Conclusion: Health care providers including nurses and school officials need to have a culturally specific understanding of the MI community and must consider their needs, culture, and language barriers.

Academic and Community-Engaged Approach to Integrating Open Educational Resources in Population Health Course.

BACKGROUND: Open educational resources (OERs) increase access to high-quality academic learning materials and promote affordable education in nursing. PROBLEM: Integrating OERs into existing nursing courses can be arduous for faculty. APPROACH: An academic and community-engaged approach involved faculty, university librarians, and community stakeholders. Community leaders and population health experts helped identify OERs for a population health theory course. OUTCOMES: Community stakeholders identified potential OERs, and university librarians assisted faculty in evaluating the OERs for quality. CONCLUSIONS: Findings illustrate the value of faculty engaging with community stakeholders to help identify OERs and with university librarians to evaluate the OERs to ensure that the information presented is relevant and applicable to course objectives.

Community Organizing to Influence Policy Change in Oregon for Disaggregated Data Collection.

BACKGROUND: The Institute of Medicine (IOM)'s Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement recommends standardized collection of the existing Office of Management and Budget race and Hispanic ethnicity categories as well as locally relevant categories of disaggregated ethnicity and languages. The lack of category standardization hinders achieving health outcomes for many populations most at risk for increasing morbidity and mortality. In Oregon state, the need to collect data from disaggregated ethnic populations had been identified but no timeline had been established for implementation. METHODS: This article describes a model for community organizing for policy change with 48 local organizations that consists of advocacy organizations, communities of color, and organizations with legislative expertise, for the Oregon House Bill 2134, which aimed to disaggregate ethnicity and language data. CONCLUSIONS: Details of the process experience with partner organizations who were at the table and key legislative strategies facilitating this policy change are discussed.

Vietnamese American Women's Beliefs and Perceptions About Breast Cancer and Breast Cancer Screening: A Community-Based Participatory Study.

INTRODUCTION: Although breast cancer (BC) rates are declining in White non-Hispanic American women, they are increasing among Vietnamese American women (VAW) at 1.2% (95% confidence interval [0.1, 2.2]) per year. BC screening rates (64%) are below the national rates (81.1%). This article explores VAW's beliefs about BC and screening. METHOD: Using community-based participatory qualitative descriptive methods, 40 VAW were recruited from Oregon, and four focus groups were conducted. A directed content analysis was used. RESULTS: Main themes were as follows: deferred to a health care provider or relying on self-detection and symptoms; fear of BC versus fear of procedural pain; limited knowledge; motivation by observing others' journey in BC death or survivorship; body image concern; "living carefree," "good fortune-having good health"; and coverage for a mammogram expense means health care access. DISCUSSION: Tailored interventions should address mammogram knowledge, fear, erroneous information, body image, fate and luck, and promoting access.

Techniques to Promote Reflective Practice and Empowered Learning.

BACKGROUND: Health care environments are fraught with fast-paced critical demands and ethical dilemmas requiring decisive nursing actions. Nurse educators must prepare nursing students to practice skills, behaviors, and attitudes needed to meet the challenges of health care demands. Evidence-based, innovative, multimodal techniques with novice and seasoned nurses were incorporated into a baccalaureate (BSN) completion program (RN to-BSN) to deepen learning, complex skill building, reflective practice, teamwork, and compassion toward the experiences of others. METHOD: Principles of popular education for engaged teaching-learning were applied. Nursing students experience equitable access to content through co-constructing knowledge with four creative techniques. RESULTS: Four creative techniques include poem reading aloud to facilitate connectedness; mindfulness to cultivate self-awareness; string figure activities to demonstrate indigenous knowledge and teamwork; and cartooning difficult subject matter. CONCLUSION: Nursing school curricula can promote a milieu for developing organizational skills to manage simultaneous priorities, practice reflectively, and develop empathy and the authenticity that effective nursing requires. [J Nurs Educ. 2018;57(2):115-120.].

Health Care Providers' Perspectives on Barriers and Facilitators to Cervical Cancer Screening in Vietnamese American Women.

INTRODUCTION: Vietnamese American women (VAW) are diagnosed and die at twice the rate than White non-Hispanic American women (16.8/100,000 vs. 8.1/100,000 and 4.4/100,000 vs. 2.4/100,000, respectively). Despite efforts to increase cervical cancer (CC) screening among VAW, the participation rates are persistently low (69% to 81%). The purpose of this study was to explore health care providers' (HCPs) perspectives on barriers and facilitators to CC screening in VAW. METHOD: This qualitative descriptive pilot study, used open-ended semistructured interviews with 10 HCPs. RESULTS: The HCPs had two to 23 years treating VAW. Major barriers and facilitators identified by the HCPs were as follows: VAW's decision making about CC screening; sexual health divide; language discordance, relying on interpreters; breaking suspicion; VAW's exposure to health sources of CC screening; sustainable trust; and motivated health care practices. DISCUSSION: HCPs perceived the reasons for VAW not being screened or delaying CC screening were due to their lack of knowledge, cultural barriers, language, and issues related to trust.

Interactive CO-learning for Research Engagement and Education (I-COREE) Curriculum to Build Capacity Between Community Partners and Academic Researchers.

The voice of diverse communities continues to be minimal in academic research. Few models exist for education and training of new research topics and terminology and building partnership capacity in community-engaged research. Little is known about integrative education and training when building participatory research partnerships for sustainability and developing trust and rapport. Community partners at an Asian community-based health and social services center in a large metropolitan area wanted to explore the cultural context of a health-assistive smart home that monitors and auto-alerts with changes in health. With historical and recent rising trends in culturally insensitive research in several diverse communities, the concept of technology-enabled monitoring in the privacy of one's home brings uncertainty. Academic nurse researchers and community partners co-created a culturally safe integrative education and training curriculum, the Interactive CO-learning for Research Engagement and Education (I-COREE). The purpose was to design, implement, and evaluate the curriculum to respond to the community partners' needs to create a culturally safe space through an integrative education and training to facilitate building partnership capacity for research engagement including developing trust and rapport and addressing uncertainties in health-assistive technologies. Popular education tenets informed the curriculum. Twelve academic and community partners participated, four were team teachers who co-led the session. Implementation of the experiential, multimodal co-learning activities were conducted within ahalf-day. The curriculum evaluation indicated that it helped bridge critical conversations about partners' fears of the unknown, approach culturally sensitive topics safely, and trust and rapport. Key elements may be translatable to other partnerships.

Health-Assistive Smart Homes for Aging in Place: Leading the Way for Integration of the Asian Immigrant Minority Voice.

Caring for America's aging population is a complex humanitarian issue. The number of older adults is expected to increase to 98.5 million by 2060 with a 295% growth in foreign-born older adults, including Asian immigrants. Most older adults will have one or more chronic conditions and 95% of healthcare costs will be attributed to caring for these conditions. Among Asian Americans, common chronic conditions include respiratory disease, cancer, cardiovascular disease, and pain. The National Institutes of Health, Institute on Aging, and National Science Foundation call for innovative technologies to be developed by multidisciplinary teams to address these concerns. Asian community leaders at Asian Health & Service Center and community members in Oregon identified the use of health-assistive technologies as a priority for potentially reducing stress and improving quality of life for both older adults and their caregivers. The purpose of this article is to introduce nurses and healthcare workers, advocating for the interests of Asian/Pacific Island community members, to the innovative health-assistive smart home. The health-assistive smart home uses artificial intelligence to identify and predict health events. Inclusion of minority persons' data in the development of artificial intelligence has been generally overlooked. This may result in continued health inequities and is incompatible with the goals of global health. Integration of minority voices while exploring the efficacious use of the health-assistive smart home is of significant value to minority populations. Asian immigrant older adults engaging in smart home research and development will enhance the cultural and technical safety of future devices. Asian families may be particularly interested in smart homes for extending independence because they place an emphasis on collective culture and family-based care. Community engagement of stakeholders and steadfast leadership are needed so that future technologies used in healthcare delivery are both technically and culturally sound. A community-engaged research approach promotes community empowerment that is responsive to community identified priorities and is a good fit for studying adoption of smart home monitoring for health-assistance.

Community Interactive Research Workshop Series: Community Members Engaged as Team Teachers to Conduct Research.

BACKGROUND: Vietnamese women are diagnosed with cervical cancer at twice the rate of non-Hispanic White women and the highest compared to Chinese, Filipino, Korean, and Japanese women. ἀ e Vietnamese Women's Health Project, a community-based participatory research partnership, was developed to address this concern. In earlier studies, community members received research training. OBJECTIVES: To describe how we developed an innovative curricular research training framework. Community members developed their own learning goals and activities, taught alongside a nurse scientist, and participated in a community interactive research workshop series. METHODS: Popular education principles were used to guide team teaching. Topics, learning goals, lesson plans, and an evaluation w ere de veloped t ogether. ἀ ree, 4 -5.5 h our workshops were hosted. Topics included qualitative research, art of hearing data, reflexivity, analysis, validity, and dissemination. Community members and a nurse scientist co-constructed knowledge through participatory methods. ἀe workshops ran concurrent to the study timeline to inform community members' research activities and vice versa. A range from 8 to 20 participants attended the workshops, of which six community members were team teachers and three facilitated at each workshop. In an evaluation, team teachers reported workshop strengths: an empathetic and trusting learn ing environment, a sense of ownership in learning, a greater under standing of roles in research partnerships, and a feel ing of safety to conduct research with academic investigators. CONCLUSIONS: Academic investigators need to be aware that co-constructing knowledge is foundational to long-term sustainability of community-based participatory research partnership (CBPR) partnerships, but requires building team capacity to conduct research collaboratively.