Winter quarter 2023 Tier 1 pilot grantees report progress in their projects

Socioecological conflict in Brazil: Equitable land tenure, ecosystem destruction, and health

Investigators
Julianne Meisner, Department of Global Health
Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Kevin Bardosh, Department of Environmental & Occupational Health Sciences
Tabata Berg, State University of Campinas
Emilio Nieto, University Center of Viçosa
Krista Jacobs, Landesa

Project update
Degradation compromises ecosystem services and facilitates the spillover of novel viruses into human settlements in Brazil. The regional biomes of the Amazon, Pantanal, and Cerrado have been inhabited by Indigenous ethnic groups and Quilombola people for centuries, and ecosystems managed by these communities are resistant to degradation, indicating such governance structures may convey resistance to pathogen emergence. Through formative qualitative data, we intend to generate proof-of-concept results demonstrating that land tenure regularization for Quilombola communities reduces ecosystem degradation.

We began data collection in Mata Cavalo in June of 2023. Data collection activities have been led by Brazilian researchers, specifically Dr. Tabata Berg, a social scientist from the University of Brasilia, and Prof. Emilio Nieto, a veterinarian and expert in agrarian reform from UniVicosa. Dr. Julianne Meisner, the UW PI, traveled to Mata Cavalo in June of 2023, coinciding with Dr. Berg’s ethnographic immersion and the first community workshop. Mata Cavalo is comprised of six smaller communities, comprised of descendants of the six families that remained in the territory during the period of deterritorialization; data have been collected in Mutuca, Mata Cavalo de Cima, Capim Verde and Mata Cavalo de Baixo.

The academic team spent July and August in Mata Cavalo to collect data and host two workshops, requested by the community as an alternative to individual participant incentives/compensation. In June, we organized a half-day workshop on Quilombola identity, history, and resistance, facilitated by an expert in Brazilian social thought and critical race theory from the University of Sao Paulo. In July, we hosted a two-day workshop facilitated by a Brazilian attorney on federal and international rights of traditional peoples and communities, specifically legislation concerning Quilombola communities and land rights, available legal assistance for communities seeking to access affirmative Quilombola public policies, and opportunities to build a network of solidarity.

Data collection by both the academic team and community fellows is ongoing. During June and July, the academic team completed an ethnographic immersion in Mutuca; six in-depth interviews with community leaders from Mutuca and Capim Verde; participatory mapping in Mutuca and de Cima with six participants in total; three transect walks in Mutuca; and questionnaires administered to 84 families in de Cima and Mutuca. Dr. Berg will return to Mata Cavalo later in September to complete in-depth interviews and hold focus group discussions. Two community fellows were selected by their community and hired in July. These fellows—one youth and one elder—supported administration of the questionnaire, and have continued ethnographic immersion in Mata Cavalo de Cima, Mata Cavalo de Baixo and Mutuca. We have also hired two undergraduate students, one from the University of Brasilia and a second from UniVicosa, who are conducting transcription and analysis.

Understanding unmet needs among people with violence-related spinal cord injury: A mixed methods study

Investigators
Heather M. Barnett, Department of Rehabilitation Medicine
Deepika Nehra, Department of General Surgery
Catherine Wolff, Department of Anesthesiology & Pain Medicine
Chelsea Hicks, Department of Pediatrics
Deborah Crane, Department of Rehabilitation Medicine
Jeanne Hoffman, Department of Rehabilitation Medicine
Monica Vavilala, Department of Anesthesiology & Pain Medicine

Project update
This project team proposed a novel evaluation of access to medical care and rehabilitation services after violence-related spinal cord injuries (SCI) in a mixed methods study of SCI patients treated at Harborview Medical Center. During the period of this award thus far, we have completed our analysis of outpatient care of people with spinal cord injury (SCI) due to violence who live in King County using data from the Harborview Trauma Registry and electronic medical record. We found that individuals with violence-related SCI received less outpatient services, including SCI physician, physical therapy, occupational therapy, and recreational therapy services, compared to individuals with other traumatic etiologies of SCI, as we had hypothesized. Individuals with violence-related SCI had fewer appointments with these healthcare providers and missed a greater percentage of visits. A manuscript with these findings was prepared and submitted and is now published in the journal PM&R. In addition to the outpatient care received by this patient population, we also evaluated the details of surgical care provided to patients with violence-related SCI. We found that there were significant differences in timing of spine surgery and in injury severity based on violent vs. non-violent etiology of injury. A manuscript describing these findings is currently being prepared for submission.

In addition, we have finalized our questionnaire and interview guide to investigate patient perception of access to care (including barriers and facilitators such as transportation access, distance, community support, and healthcare system issues), patient-identified met and unmet needs, patient opinion on current and past support programs for those who participated in these initiatives, and suggestions for improvement. We have discussed our survey and interview materials with two relevant community advisory boards: the Northwest Regional Spinal Cord Injury System Community Advisory Board and the Harborview Injury Prevention and Research Center Community Advisory Board. These groups have provided guidance and feedback to optimize our approach to this investigation which we have incorporated into our finalized questionnaire and interview guide. We have also finalized our recruitment materials, and we are now beginning recruitment for this part of the study.

Understanding the needs of families caring for Chinese American older adults and opportunities for digital health tools to promote health equity

Investigators
Andrea Hartzler, Department of Biomedical Informatics and Medical Education
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Michael Woo, Kin On
Cindy Dong, Pacific Northwest Chinese Nurses Association
Weichao Yuwen, School of Nursing & Healthcare Leadership (Tacoma)

Project update
In 2020, over 50 million family caregivers provided care for older individuals and people with disabilities in the U.S. Providing care to a loved one can be physically, financially, and emotionally stressful. In particular, Asian Americans and family caregivers of Chinese-speaking older adults reported high levels of emotional stress more often compared to English- or Spanish-speaking caregivers. Digital health tools have the potential to provide affordable and accessible real-time support for family caregivers. Yet creating such tools requires a foundational understanding of caregivers’ experiences and the shared needs specific to the community.

In collaboration with our community partner organization, the first aim of this project is to conduct interviews to understand the needs of families caring for Chinese American older adults and the caregiving ecosystem. The second aim is to Investigate the interview findings with community partners to identify opportunities for digital health tools to help address not only unmet caregiving needs but also family caregivers’ self-care needs.

To date, the team has achieved the following:

• Conducted extensive literature review on Chinese American family caregivers’ caregiving needs and related cultural factors. Based on the gaps identified in the literature, produced and refined the interview guide.
• Conducted monthly meetings with staff members at our community partner organization to refine the interview recruitment plan and interview materials. The staff members have rich experience in serving the local Asian community and expertise in working with the Chinese American elderly and their families. They provided insights into the current resources for community organizations to assess family caregivers’ needs and resources for family caregivers, including tailored care packages and counseling services. We are planning on arranging key informant interviews with staff members from the community partner who directly work on supporting family caregivers.
• Pilot tested the interview guide with two Chinese-speaking colleagues and made changes accordingly. In particular, we enhanced the section of the interview guide that asks about cultural factors.
• Obtained an IRB determination of exemption and recruited participants at community events organized by our community partner.
• Actively recruiting participants for interviews in collaboration with our community partner.

Community Healing: Lessons from Asian Organizers for Mental Health Providers

Investigators
Jondou Chase Chen, College of Education
LeiLani Nishime, Department of Communication

Project update
The purpose of this project is to learn about the experiences, values and the aspirations of Asian non-binary and women community educators, artists, healers, and organizers who are invested in the mental and physical well-being of Asian communities in Seattle to inform a curriculum for a Continuing Education Unit workshop for mental health providers. By learning how they make sense of their experiences and how they bring their values to their respective community learning spaces, we can support mental health professionals in their practices in meaningful and sustaining ways for Asian clients.

To date, we have been able to host introductory one-on-one interviews, five group workshops, concluding one-on-one interviews and transcribe all interviews and group workshops with 15 community partners. We have also completed data analysis and have been able to meet with each community partner for community validation (i.e., member checking). We began working on a community zine based on the findings from the research, which is one portion of the Continuing Education Unit workshop handouts. We are currently reaching out to mental health educators to host us in creating and planning the CEU workshop.