Awardees of 2021 pilot research grants report final project outcomes

Addressing Inequities in Speech-Language Pathology Services for Children with Communication Disorders

Investigators
Sara Kover, Department of Speech and Hearing Sciences
Carly Roberts, College of Education
Natasha Arora

Project summary
This research was designed to deepen understanding of contributors to disparities in speech-language pathology (SLP) service delivery to children with communication disorders of diverse racial, cultural and linguistic backgrounds, as well as to initiate local community connections.

Through this project, we have connected with nearly two dozen (N =23) SLPs and administrators in King and Pierce Counties in both public school settings and early intervention settings. Using qualitative interviews, we sought to understand the perspectives and experiences of those who provide or oversee speech-language pathology services to children with communication disorders of diverse backgrounds. These professionals leverage strategies for culturally responsive practices, while also encountering barriers that range from limited time to connect with families or students to policies and processes in the broader system of service delivery.

Personal identity (e.g., race, ethnicity, bilingualism), personal growth (e.g., cultural humility) and on-the-job learnings, along with access to interpretation/translation and representative materials were additional themes related to equitable services in both public school and early intervention settings. Further findings related to facilitators and barriers to equitable service delivery will inform next steps for community collaborations.

Characterizing Risk Communication around Smoke Exposure in Rural and Tribal Communities in the Okanogan River Airshed Emphasis Area

Half of the funding for this award came via a partnership with UW’s EarthLab, which works in partnership with others to co-produce and catalyze actionable science.

Investigators
Ernesto Alvarado, School of Environmental and Forest Sciences
Savannah D’Evelyn, Department of Environmental & Occupational Health Sciences
Nicole Errett, Department of Environmental & Occupational Health Sciences
Cody Desautel, Confederated Tribes of the Colville Reservation

Project summary
As wildfire seasons increase in frequency and intensity, the Pacific Northwest is facing a public health crisis of extreme wildfire smoke. Rural and tribal communities in the Okanogan River Airshed Emphasis Area (ORAEA), which includes the towns of Omak and Okanogan, as well as the Western Colville Reservation, are highly impacted by smoke from both wildfires and prescribed fires. In 2021, over 140,000 acres burned in the ORAEA, and 41% of days had moderate or worse air quality. Because of this, communities in the ORAEA have a unique perspective and practiced expertise in smoke readiness and communication.

Through a series of interviews and focus group discussions, we sought to learn from the perspectives of tribal and non-tribal community members in the ORAEA about how they approach wildfire smoke risk communication. Over the course of six months, we hosted 17 virtual interviews and six in person focus groups to learn about smoke risk communication from the community perspective. From these conversations, we did a thematic analysis and distilled the strengths and challenges that interviewees identified into five themes: 1) perception of the health risks of smoke; 2) current ways of sharing information about smoke; 3) trusted sources of information; 4) gaps and opportunities; and 5) perceptions of prescribed fire.

Based on these themes, we also developed a set of six recommended actions to share with other communities in the region who are similarly impacted by smoke. These recommendations have since been shared with multiple community organizations within and beyond the ORAEA, as well as at a virtual stakeholder event for interviewees and other community members.

Recommendations:

• Clarify what is known about the short-, medium-, and long-term impacts of wildfire smoke, including mental health impacts.
• Clarify the actions people can take to mitigate the health impacts of smoke exposure.
• Coordinate between local groups to ensure accuracy, consistency, and reach of risk communication.
• Emphasize one’s health and health of one’s community as central to wildfire resilience.
• Emphasize smoke-readiness and preparation.
• Address and mitigate increasingly frequent and severe wildfires.

Results from this project demonstrate that preparedness for smoke exposure varies across age and demographic groups, and that individuals feel an uncertainty surrounding the health impacts of smoke and how much they should be concerned. When it comes to avoiding smoke, the current strategies are often hard to build into daily life, and others are financially unrealistic for certain populations. Risk communication around smoke exposure revolves around social media, and is all about the local trusted source. Although learned from residents of the ORAEA and Western Colville communities, these broad themes and other recommendations made in this report are translatable to other smoke-impacted communities across the Pacific Northwest. As fire and smoke seasons continue to worsen, the number of communities and people affected will only increase.

The recommendations are meant to be utilized by practitioners working in tribal, local, state, or federal government and community-based organizations, as well as others interested in community-centered environmental hazard risk communication. Our results and the example set by the ORAEA and Western Colville reservation demonstrate that preparedness can improve the livelihoods of affected communities throughout the smoke season. A summary of this project and our six recommendations was shared on a UW blog. This blog includes links to a shareable full-length report as well as a two-page brief on our project findings.

Supporting Equitable Land Management Decisions Through the Characterization of Wildfire and Prescribe Smoke Exposure for At Risk Communities

Investigators
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences
Julian Marshall, Department of Civil & Environmental Engineering
Claire Schollaert, Department of Environmental & Occupational Health Sciences

Project summary
Prescribed burning has been identified as one of the most effective methods to mitigate future wildfire severity and facilitate forest restoration processes; all factors which could decrease future human exposure to smoke from wildfire. Despite this dual benefit, prescribed burning is an underutilized fuel management practice, in part due to knowledge gaps related to how prescribed burns may contribute to harmful smoke exposures relative to those from wildfire. This project aims to fill that gap by quantifying the spatiotemporal distribution of exposure to wildfire and prescribed burn smoke across Washington, Oregon and California from 2012-2020.

We developed a novel biomass burning emissions inventory that distinguishes between sources of smoke, using the Fire INventory from NCAR (FINN), which provides total fire emissions estimates for different vegetation categories such as forests or shrublands, irrespective of the ignition source. We reclassified this baseline inventory to distinguish between wildfire, prescribed burn, and agricultural burn sources using a combination of observations from satellite products as well as federal and state-level administrative databases. We then used that biomass burning emission inventory to simulate the contributions of wildfire and prescribed burning emissions to surface fine particulate matter (PM2.5) concentrations, using an atmospheric chemical transport model.

Preliminary results indicate that total biomass burning emissions varied by state throughout the study period, with California producing 4.8 billion kg of PM2.5, Oregon producing 3.0 billion kg of PM2.5 and Washington producing 1.2 billion kg of PM2.5 from 2012-2020. The relative contributions of each smoke source also varied by state.

Preliminary results from the first three years of our transport modeling (2013-2016) show that the magnitude and intra-annual temporal distribution of PM2.5 concentrations vary across sources, with wildfire-specific smoke dominating during the summer and early fall, and smoke stemming from prescribed burns being more prominent in the late fall, winter, and early spring. We also found that the spatial distribution of PM2.5 concentration varies across sources.

We are now wrapping up the final years of our transport modeling and are starting to examine source-specific exposure patterns among at-risk subpopulations. Through our work generating the source-specific biomass burning emission inventory, we also identified agricultural burning as a comparable source of smoke emissions in these three states, relative to emissions from prescribed burns. We intend to include these emissions observations in future work in order to quantify the impacts of agricultural burns on population-level exposures and compare those with our wildfire and prescribed burn smoke exposure estimates.

A Collaboratory to Support Equitable and Just Climate Action

Investigators
Jeremy Hess, Departments of Emergency Medicine, Environmental & Occupational Health Sciences, and Global Health
Jason Vogel, Climate Impacts Group
Julian Marshall, Department of Civil & Environmental Engineering
Sara Curran, Jackson School of International Studies and Department of Sociology
Kris Ebi, Departments of Environmental & Occupational Health Sciences and Global Health
Nicole Errett, Department of Environmental & Occupational Health Sciences
Andrew Dannenberg, Departments of Environmental & Occupational Health Sciences and Urban Design & Planning
Tania Busch Isaksen, Department of Environmental & Occupational Health Sciences
Esther Min, Front and Centered
Deric Gruen, Front and Centered
Tim Sheehan, Department of Environmental & Occupational Health Sciences

Project summary
The Collaboratory is an ambitious interdisciplinary partnership between several groups at the University of Washington (UW) and Front and Centered (F&C), a coalition of environmental justice organizations in Washington State. The goal of the Collaboratory is to bring together F&C’s expertise and experience with community engagement and translation of community priorities into policy platforms with the UW’s expertise in policy analysis and health impacts assessment to assess the potential health impacts of community priorities regarding decarbonization and develop a platform for visualizing these potential impacts. Decarbonization, which emphasizes a transition away from fossil fuels, has the potential for significant health benefits through reduced air pollution, increased active transpor, and other pathways. A just transition as envisioned by F&C will ensure that these benefits will accrue equitably to historically disadvantaged and frontline communities.

The project funded by the Population Health Initiative (PHI) had three specific aims (SA): SA1 was to develop a standardized, collaboratively owned, community-led process for soliciting, collecting, and reporting community priorities using qualitative research methods, to develop mechanisms for community data ownership, and to develop standardized practices for reflecting findings back and linking to larger policy platforms. SA2 was to develop a shared model for co-producing policy platforms, scenarios for policy analysis and health impact assessment (HIA), and two preliminary HIAs of priority policy platforms. SA3 was to develop a web-based platform for visualizing EHD and climate-related health risks, populated with baseline demographic, climate, land use, air pollution, and other information at census-tract levels, and to use the platform to present HIA results from SA2.

The Collaboratory began its activities in late spring of 2021 and is ongoing. The PHI’s initial investment in the Collaboratory is complete, and we are excited to report success across each of the Collaboratory’s three priority areas.

The Collaboratory achieved SA1 by developing and adhering to a shared, mutually agreed-upon process for developing priorities, generating data, sharing access to data and analyses, and communicating regarding the shared work. In service of SA1, members of the Collaboratory developed a 32-point Memorandum of Understanding (MOU) that outlined the principles and practices for the agreement, including responsibilities and expectations of all parties, principles of partnership, community engagement, decision making, work ownership, and understanding regarding shared communication of the work. The MOU was signed by Collaboratory members as well as signatories for the two organizations. This MOU has served as a guiding document for other community engagements between organizations in the UW School of Public Health since it was developed and signed.

Progress on SA2 was steady but slower than anticipated given the unexpected complexity of the process. This complexity came from two sources: the need for shared learning about a number of topics, and the need for additional expertise not already available to the team. In regards to learning needs, members of the Collaboratory spent several months in shared discussion and learning focused on several areas, including F&C policy priorities for a just transition; Washington State’s plans for decarbonization; how the Shared Socioeconomic Pathways can be used to support modeling the health impacts of decarbonization; and requirements for using InMAP, co-investigator Marshall’s reduced form air pollution modeling platform. This learning and exploration was necessary, as each discussion led to a new set of learning needs in the group, but took longer than originally anticipated. In regards to needed expertise, in the policy development phase, F&C members articulated two priorities for the 2022 Legislative Session (see here), energy assistance and a just and equitable transportation standard, and identified the transportation standard as their priority for the Collaboratory. Estimating changes in air pollution source emissions associated with this standard required expertise in transportation network modeling that was not available to the team. At the end of the project, the team was not able to develop detailed policy scenarios for modeling, but the group had developed significant shared insight regarding processes and needs that will feed into next steps.

Despite slow progress on SA2, the team was able to make progress on SA3. Leveraging a platform developed by the Center for Health and the Global Environment (CHanGE) for visualizing health risks associated with climate-sensitive hazards, the team developed and finalized a fuzzy logic modeling approach and web-based visualization platform for characterizing health and equity impacts of emissions associated with different policy choices. The platform is operational for climate-related health risk modeling but has not yet been populated with data on decarbonization strategies, however, additional work will need to be done to provide guidance on data visualizations once these data are available.

After a year of concerted effort, the Collaboratory has developed a strong shared understanding and multiple processes for pursuing community-led policy analysis and health impact assessment. Collaboratory members also have a much deeper shared understanding of the processes, tools, and approaches available for pursuing shared goals, and of community members’ priorities regarding next steps in the just transition. Lastly, the Collaboratory has developed viable methods for modeling and depicting the health impacts of policy choices. The team has also identified additional needs for moving forward, including additional transportation modeling expertise.

Addressing the Need for Culturally Responsive and Bidirectional Research Communication with the Latinx Community – The BRIDGE Project

Investigators
Nathalia Jimenez, Department of Anesthesiology & Pain Medicine
Carmen Gonzalez, Department of Communication
Daniel Cabrera, Department of Medicine
Diana Maria Oliveros, Mexican Consulate in Seattle
Meg Gomez, School of Social Work
Aida Hidalgo, School of Public Health
Mikaela Freundlich Zubiaga, UW Latino Center for Health

Project summary
Responding to the need for sustainable academic-community partnerships to address the burden of COVID-19 in Washington State Latinx communities, the Bi-directional Research Digital Engagement (BRIDGE) Program follows a two-phase approach. In Phase I, BRIDGE brings the voices of the Latinx community through digital storytelling to highlight the burden of COVID-19 on their health and well-being; and develops educational/informational videos with bicultural/bilingual faculty and students informed by these stories. Phase 2 creates video clips to amplify the experiences of the community through culturally appropriate outlets and with students within the University of Washington community via curriculum content for medical students in the Latino health pathway. Preliminary engagement analysis include number of Facebook users who received the videos, and engagement measured by number of people who reacted to the post- likes/shares and comments).

For Phase 1, partnering with Latinx community advocates and identifying academic partners, the BRIDGE team identified and successfully partnered with three Latinx community advocates whose work bring awareness to:

1. Immigrants living in detention centers: Maru Villalpando, Leader of la Resistencia, an organization led by detained and formerly detained people, brings awareness to the lack of protective measures and barriers to access health care for detainees during the pandemic; and their work in partnership with researchers and physicians from the UW to attend to their healthcare needs. Angelina Snodgrass Godoy, a University of Washington Professor in Law, Societies and Justice, describes her partnership with la Resistencia organization and the key elements for this partnership to be successful; mutual respect, academic humility and centering the efforts around the community needs.
2. AfroLatinx artists: Milvia Pacheco, Afrolatina artist, explains how their work and livelihood was severely affected during the pandemic and how their community organized to support community self-funding efforts. Linda Ko, Asian Latina University of Washington Professor of Health Systems and Population Health, describes principles of reciprocal and respectful community participatory research with emphasis on how to create and maintain these partnerships.
3. Latinas who were pregnant and gave birth during the pandemic: Jazmin Herrera, mother, and community patient navigator, describes the effect of isolation in the mental health of pregnant mothers and the barriers to access linguistically and culturally sensitive care during the pandemic. Mariana Frias, Latina Family Physician working at a community health care center, describe the importance of support systems for new mothers and the need for patients to advocate for their needs.

In Phase 2, dissemination, we produced nine video clips (five to seven minutes each) highlighting main themes.

• Dissemination to academic community: We created a website and posted videos with links to partner organizations to increase awareness about their work.
• Dissemination to the Latinx community: Videos were posted in the Mexican consulate website with a press release. Overall, we reached between 479 to 900 individuals depending on the episode posted. Minimum engagement was seven reactions per video post and maximum 85.
• Education and Training: We are currently creating online curriculum modules for the Latinx Pathway. These modules guide students to think about social determinants of health and how these affected Latinx communities during the pandemic. We also cover aspects of equal partnership between academia and communities of color and the effect of institutional racism on these partnerships.

Rapid Community Partnered Mixed-Methods to Promote Vaccine Uptake in Diverse Communities

Investigators
Theresa Hoeft, Department of Psychiatry & Behavioral Sciences
Bonnie Duran, School of Social Work
Diem Nguyen, Department of Psychiatry & Behavioral Sciences
Morhaf Al Achkar, Department of Family Medicine

Project summary
In April 2021 we were funded to further develop partnerships to support our collaborative work and to develop a draft toolkit to support community partnered rapid mixed methods research. Such methods were motivated by the COVID-19 pandemic and the need for such methods during previous times of crisis (e.g., previous pandemics, natural disasters). We are interested in also applying these methods to evolving partnership work in implementation research that seeks to reduce health disparities. We planned over this one-year grant to:

• Develop relationships further with our community partners at the Vietnamese Health Board (VHB) and develop a Community Advisory Board of diverse partners from the VHB and broader Community Health Board Coalition (CHBC)
• Develop a draft toolkit for community partnered rapid mixed methods research
• Seek advice in toolkit development from a methods advisory group of experts in mixed methods research, implementation science and community-based participatory research (CBPR)
• Develop a quantitative survey and qualitative interview guides as a part of the toolkit to assess barriers and facilitators to vaccine uptake and accessing health care more generally
• Evaluate our partnership work together developing the community partnered rapid mixed methods research toolkit

We have worked in collaboration with members of the CHBC to develop a draft toolkit that we plan to pilot and refine in a future grant. Two co-Investigators on this grant are also members of health boards within the larger CHBC – the VHB and Iraqi/Arab Health Board. Eleven other members of the CHBC joined us in Community Advisory Board (CAB) meetings to help plan the developing toolkit. We also received support from the methods advisory group, which included Dr. Duran from the UW team along with four other advisors coming from academic or public health agency settings. Since the toolkit is intended for an academic, public health agency, and community co-researcher audience, these meetings helped us develop content while anticipating feasibility and acceptability of the toolkit from these perspectives. Our next grant we will assess feasibility and acceptability of the toolkit for these audiences.

As the toolkit evolved it become clear that developing data collection tools such as qualitative interview guides and a quantitative survey that would be useful to one health board (e.g., the VHB) or across multiple health boards was a lower priority and that instead the toolkit should harness data collection tools that have already been implemented in partnership with communities, both during the COVID-19 pandemic and pre-COVID. We thus modified this segment of the toolkit to focus on and elevate existing data collection tools. This toolkit section takes a broader focus on assessing community needs exemplified by these existing tools.

We also developed a process for checking in to evaluate our developing relationship throughout the grant. We began check-ins through informal conversations at the end of meetings in a manner that mimicked the format for engaging feedback within CHBC meetings. Later we modified this to include a zoom poll with partnership evaluation questions taken from an academic paper by Blake Boursaw and colleagues highlighted in the toolkit. We may further refine this process at a later meeting with the CAB in August to review the draft toolkit. The match funds from the Department of Psychiatry and Behavioral Sciences are supporting these continued meetings with the CAB since April 2022.

Co-Designing a Culturally-Responsive, Advanced Technology Intervention to Support the Health and Development of Young Children in King County

Investigators
Julie Kientz, Department of Human Centered Design & Engineering
Kendra Liljenquist, Department of Pediatrics

Project summary
The purpose of this project was to engage in collaborative design efforts to develop more advanced smartphone-based interventions to provide culturally relevant activities and health recommendations. Aim 1 was to establish racial/ethnic minority parents’ expectations regarding cultural relevance when interacting with a mobile-based interface for their child’s health and development.

We completed two focus group sessions with parents who identified as West African, low-income, first-generation immigrants, and members of the community organization we partnered with for recruitment and guidance on the content of the research sessions. All the parent participants were the primary parent of at least one child under age 5. In these sessions, we aimed to 1) hear parents’ lived experience with navigating guidance about their child’s health, 2) identify successes and challenges when acting on child health guidance in their daily life, and 3) document who or what (e.g., resources) they rely on for support to be successful in their parenting practice. From these two sessions, we had three key findings.

• First, parents expressed that while information about their child’s developmental progress is essential, they felt limited in the action they could take due to stressors from their environment (e.g., financial, food, and housing security).
• Second, parents rely on guidance and support from family, friends, the community organization, and health providers related to their child’s health.
• Third, technology primarily supports this group of parents with organization and planning, including budgeting, keeping track of appointments, and communicating with their trusted support networks.

Working with our community partners, we conducted four, three-part co-design sessions with 16 parents (across English, Spanish, and Somali languages), four clinicians and six community health workers to inform the design of a new primary care-based developmental screening and response intervention. This work identified 1) where parents currently get information and support regarding developmental promotion, 2) types of information and support parents would like to receive from their care-teams regarding developmental promotion and parent well-being, and 3) specific features of a developmental screening and response intervention needed to be accessible to parents. Specific to technology, parents seek support for their child’s development in three ways.

• First, they utilize communication mechanisms like group texts and WhatsApp to ask for advice from family, friends, and other parents on how to address questions or concerns they have about their child’s health and development.
• Second, they follow parenting pages on apps like Instagram or use search engines to identify websites that provide information about child development and activities they can do to promote healthy development.
• Third, parents search for videos that support early learning on YouTube and other media streaming services for their children to watch.

In sharing these experiences parents shared frustrations relating to the uncertainty of who and what to trust. Concern about videos and ads not appropriate for children showing up on places like YouTube as well as a general feeling of disconnections when having to navigate websites independently, left many parents desiring more structured support and advice on developmental promotion.

Overall, parents utilize technology in varying ways to support their child’s development and find it beneficial to have someone like a Developmental Navigator as part of their care team to help them connect with and utilize resources in the best ways possible. Parents also shared the importance of using technology to communicate with and support each other. Recognizing this, it is important to consider the larger ecosystem our developmental promotion tool will sit within and design it in a way that facilitates communication across parents and early childhood professionals while providing trustworthy developmental promotion information and activities in an accessible way.

For Aim 2, we sought to create a usability assessment method using heuristic evaluation with expert preventive care and health promotion technology designers. We engaged four Human-Centered Design and Engineering students in a credit-based Directed Research Group to generate heuristics for evaluating health promotion technologies for children based on a review of the literature. We then engaged eight technology designers with prior experience in health technology design, including telemedicine, healthcare IoT products, and state and local government health programs in evaluation of those heuristics.

To evaluate the performance of our heuristic method, we asked evaluators to rate child development promotion apps from the Apple and Google App Stores, using both our new set of heuristics and heuristics traditionally used in the field for usability evaluations (e.g., Jakob Nielsen’s heuristics). Our results demonstrate that evaluators using Nielsen’s heuristics identified more usability-focused issues than those identified by the reading group, however severity ratings across both Nielsen’s heuristics and the reading group heuristics were consistent. From the evaluator’s descriptions, it is clear that our developed heuristics were understood as requirements across the content and design of the mobile app, and not specific to user experience design principles. Evaluators categorized the heuristics as a useful tool, but ineffective for the stage of evaluation we asked them to engage in. As such, the utility of the heuristics we developed may be better suited for earlier in the design process, when designers are identifying the components of their systems. We have completed a paper draft of this work and will be submitting it to a top health informatics journal (Journal of the American Medical Informatics Association, JAMIA) by Fall 2023.

Community-Based Formative Research to Advance Reproductive Health Equity in Iñupiaq Alaska

Half of the funding for this award came via a partnership with the UW Office of Global Affairs, which seeks to enhance the UW’s global engagement and reach, including with sovereign tribal nations.

Investigators
Elizabeth Harrington, Department of Obstetrics & Gynecology
P. Joshua Griffin, School of Marine and Environmental Affairs and Department of American Indian Studies
Dian Million, Department of American Indian Studies
Corina Kramer, Maniilaq Association
Lucas Trout, Maniilaq Association

Project summary
The goals of our grant were to build a long-term, multi-disciplinary research collaboration between the UW and Maniilaq Social Medicine, and to understand the social, medical and geographic contexts framing Alaska Native (AN) women’s reproductive experiences and outcomes in Northwest Alaska.

Our team prioritized collaboration, participatory methods, and community input in our multi-method qualitative research. We successfully formed a community advisory group of seven women representing several villages in the Maniilaq service area, and incorporated their perspectives as we further developed our research questions and plan. The UW and Social Medicine Program (SMP) co-investigators provided research mentorship to Margaret Smith, SMP Program Coordinator, and Savannah Jones, Maniilaq Women’s Health Clinic nurse; they co-created the study instruments with co-investigators, provided input on recruitment strategies, and Margaret conducted in-depth interviews. Our team remotely conducted 15 in-depth interviews with reproductive-age women residing in 7 of the 12 Maniilaq service area villages, as well as 11 key informant interviews with women’s health providers,
village health aides, community leaders, and elders. Our analytic team coded the qualitative interviews in Dedoose using a deductive-inductive coding structure with a constant comparison approach. Drawing on preliminary themes from this analysis led the development of our community workshops. We conducted two workshops, one in Kotzebue and one in Kivalina, with a total of 12 participants.

Among reproductive-age women participants, we found that sexual and reproductive health (SRH) experiences, including family planning and pregnancy care, were deeply impacted by the quality of trust and communication with providers. Dual relationships with providers and confidentiality were major concerns, especially regarding sensitive issues such as abortion and sexually transmitted infection screening and treatment. For village residents,
accessing air travel posed major barriers to SRH care, including contraceptive choice; travel costs are not covered for “early” removal of long-acting reversible contraceptives prior to completing their full duration of use. Several Key Informants brought up housing shortages and lack of SRH information among youth as drivers of SRH outcomes. They named respect for Iñupiaq culture, addressing intergenerational trauma, and access to subsistence foods as critical aspects of SRH.