Awardees of 2022 Tier 3 pilot grants share their final project outcomes

Community Pharmacist Epilepsy Services Program

Investigators
Jennifer Bacci, Department of Pharmacy
Edward Novotny, Departments of Neurology and Pediatrics
H. Steve White, Department of Pharmacy
Andy Stergachis, Departments of Pharmacy and Global Health
Sabra Zaraa, Department of Pharmacy
Michelle Guignet, Department of Pharmacy
Kari VanderHouwen, Duvall Family Drugs and CPESN Washington

Project summary
The objectives of this project were to (1) develop and evaluate a training program for a community pharmacist population health intervention for people living with epilepsy (PWE) and (2) implement and evaluate the impact of the community pharmacist population health intervention on PWE’s quality of life (QoL).

A training program was developed for community pharmacists and was composed of five, one-hour, self-paced online modules and two, 90-minute synchronous virtual sessions. The training program was delivered over six weeks to six pharmacists from two independent pharmacies in Washington State from November 2022 to January 2023. Pharmacist knowledge and confidence were assessed using a survey administered prior to (pre) and upon completion (post) of the training program. The training program did not significantly change pharmacists’ mastery of the material, given their strong knowledge base prior to the training program. However, the pharmacists’ confidence in delivering the material significantly improved in 14 of the 16 areas that were evaluated. These findings support the idea that community pharmacists have the knowledge to play an important role in epilepsy care. However, dedicated training tailored to community pharmacists’ needs may improve their confidence in providing such care.

The community pharmacist population health intervention was implemented in the two independent pharmacies from February to November 2023. Two additional independent pharmacies served as control sites providing usual care. A prospective, two-arm, pre-post study was planned to evaluate the impact of the intervention on patient-reported quality of life (QoL), health, and satisfaction outcomes; however, a one-arm, pre-post design was ultimately used due to low patient recruitment. Staff at intervention and control pharmacies were surveyed to evaluate perceived barriers to patient recruitment. Five intervention patients completed the pre- and post-surveys. The median pre-QOLIE-10-P score was 1.09 and the median post-score was 1.73, indicating a modest but not significantly decreased QoL. Eleven pharmacy staff completed a survey to evaluate patient recruitment barriers. These included a limited number of eligible patients living with epilepsy at each pharmacy.

While low patient enrollment limited the ability to observe trends and draw conclusions about the potential impact opportunities, enrollment barriers and lessons learned highlight opportunities to refine the intervention with the goal of improving the outcomes and well-being of PWE.

Amigas Latinas Motivando el Alma (ALMA): Addressing Mental Health Needs among Latina Immigrant Women in Yakima Valley

Investigators
India Ornelas, Department of Health Systems and Population Health
Deepa Rao, Departments of Global Health and Psychiatry & Behavioral Sciences
Caty Padilla, Nuestra Casa
Magaly Solis, La Casa Hogar
Georgina Perez, Department of Health Systems and Population Health
Serena Maurer, Department of Health Systems and Population Health
Juan Gudino, Department of Health Systems and Population Health

Project summary
This project consisted of three aims: 1) Adapt the evidence-based ALMA intervention to be delivered by community health workers at two community-based organizations in the Yakima Valley; 2) Train and support community health workers to deliver the ALMA intervention; and 3) Assess the potential effectiveness of the ALMA intervention when delivered by community health workers in the Yakima Valley.

Results and Key Findings
Aim 1. We conducted 2 feedback sessions with 10 participants who had received the intervention when it was offered to staff at both community-based organizations (CBOs) in 2022. The sessions occurred over Zoom and were led by bilingual research team members. Our interview guide included questions such as “What was most impactful for you about the ALMA program?”, “Is there anything you think would be more or less impactful for your clients?”, “What kind of support would you need to facilitate the ALMA program?”, and “What kind of support would your clients need to participate in the ALMA program?” Overall, the ALMA participants reported high satisfaction with the intervention with no major suggestions for changes.

Aim 2. We trained five community health workers from La Casa Hogar (3) and Nuestra Casa (2), to deliver the ALMA intervention. Four out of the five staff members had previously participated in the online ALMA intervention. All the staff members that received the training were Latina and Spanish-speaking with several years of experience serving Latina immigrants through their CBOs. The staff members also had previous experience facilitating educational programs for community members.

The training consisted of online and in-person components and was followed by ongoing support meetings. The research team provided each CHW with a physical training manual which included detailed scripts and instructions on the content of each ALMA session, practical tips, and lists of session materials. The online training was delivered as seven weekly two-hour sessions focused on reviewing the content of each session and discussing the ALMA practices. The CHWs were supported in developing their strengths and capacity as facilitators, preparing for sessions, providing mental health support to participants, and monitoring intervention fidelity.

Following the seven online sessions, we offered a two-day in-person training “retreat” during which the CHWs had an opportunity to practice, discuss, and lead ALMA activities and practices amongst each other. The research team provided feedback on how to lead the program activities. Following the training, the research team met with the CHWs weekly while they delivered the intervention to debrief how the intervention session went, prep for the following week’s session, and offer ongoing coaching and mentorship. We provided materials to both community organizations for program delivery, such as yoga mats, handouts for the various activities, and laminated posters of the song lyrics and those needed for specific activities.

Aim 3. La Casa Hogar chose to first offer the ALMA program to their staff to gain more experience with the curriculum (n = 5). They offered the program a second time to their clients (n = 12). Nuestra Casa offered the program once to their clients (n = 25). Overall, a total of 42 women participated in ALMA programs led by the CHW facilitators. Each participant completed a survey before the intervention began (pre-intervention) and a second survey after they completed the intervention (post-intervention). Surveys included questions on demographics, depression, anxiety, mindfulness-based coping strategies, and social support. The postintervention survey included additional questions about participant satisfaction and skills learned.

We assessed intervention fidelity using a short weekly survey completed by the CHW facilitators and notes from our weekly support meetings. The survey questions about participant attendance and intervention fidelity (i.e., was there something unusual or unexpected with the session, and were you able to complete all the session components) after each session. Their survey responses were also used to discuss the sessions during the support meetings.

CHWs completed almost all program components in each session. In general, missed components were due to time constraints or facilitator absences. Participant attendance at the ALMA sessions ranged from 44 – 100% across sites. Participants reported high satisfaction with the program overall and that it helped them identify new strategies for reducing stress and maintaining their mental health. The participant surveys showed a post-intervention reduction in depression and anxiety symptoms among participants at all sites. Participant satisfaction and mental health outcomes were comparable to results from the trial in which ALMA was delivered by masters level professionals. Our findings indicate the ALMA delivered by CHWs is a promising strategy to extend the reach of the intervention into areas with limited Spanish-speaking mental health professionals.

Healing Heart and Soul: Decreasing Maternal Racial/Ethnic Health Disparities through Home-Based Monitoring of Blood Pressure, Stress/Depression, and Safety

Investigators
Rachel Chapman, Department of Anthropology
James Pfeiffer, Department of Global Health
Amelia Gavin, School of Social Work
Abril Harris, School of Social Work
Liza Perpuse, HealthPoint
Yvonne Griffin, Neighborcare Health
Tanya Sorensen, Swedish Medical Center
Katie Eastwood, Swedish Medical Center

Project summary
This was a scale-up study seeking to measure the impact of a home blood pressure self-monitoring and home screening tool on perinatal outcomes that sought to:

• Eliminate maternal/child health disparities due to elevated perinatal blood pressure (eclampsia and preeclampsia), stress and compromised mental health, and home and relationship danger and violence; and to
• Improve perinatal outcomes through improved healthcare provider response to, treatment and follow-up of perinatal hypertensive, mental health, and home/relationship crises.

The Heart, Soul, and Joy project provided training and a kit with a blood pressure (BP) cuff, a self-screening tool for centering participant joy, and home-monitoring of blood pressure, stress/depression, relationship/home safety, and domestic violence support resources to perinatal patients seeking perinatal care who were recruited and enrolled in the HSJ project at five NeighborCare Health Clinics (Rainier Beach, Columbia City, Meridian, High Point, and Lake City), HealthPoint at Midway, Hummingbird Indigenous Family Services, and Rainier Valley Birth and Health Center in Seattle, Washington.

Our findings to date confirm that when patients were equipped with BP cuffs as a home self-monitoring tool, they were able to feel empowered to use BP health data to make informed healthcare seeking decisions, utilize the data to improve their service utilization experience, and obtain timelier, and, thus, potentially life-saving health care responses. This highlights the transformative potential of universally supported home BP tools in revolutionizing perinatal care and potentially addressing disparities in perinatal health outcomes.

The home BP cuff intervention is crucial for managing gestational hypertension. Universal provision of BP cuffs is vital in detecting high BP during pregnancy, especially among marginalized populations such as Black, immigrant, low-income communities, and the uninsured or underinsured. We advocate for their widespread adoption through needed reorganizing and redistributing of Medicaid and other resources to enhance Washington State and Seattle’s maternal and infant health outcomes and reduce perinatal health disparities.

Equity Among American Indian, Alaska Native, Native Hawaiian, Pacific Islander communities under COVID-19 Telehealth Policy

Investigators
Ashok Reddy, Department of Medicine
Edwin Wong, Department of Health Systems and Population Health
Joshua Liao, Department of Medicine

Project summary
American Indian Alaska Native (AIAN) and Native Hawaiian and Pacific Islander (NHPI) communities experienced disproportionate harms from COVID-19, with the highest death rates among all racial groups in Washington state. Changes in telehealth policy could improve access to care for these communities. On one hand, these changes could reduce barriers to care in ways that could markedly benefit these communities (e.g. reducing transportation burdens). However, these changes may have revealed new barriers that worsen disparities in access (e.g. services may require reliable broadband internet).

In view of both longstanding and COVID-specific inequities, it is critical to understand how telehealth policies impact the NHPI and AIAN communities. We aimed to understand how telehealth policies impacted telehealth use among the Native Hawaiian and Pacific Islander (NHPI) and American Indian and Alaska Native (AIAN) communities. Our project had two main goals: (1) apply our expertise in health care disparities, AIAN and NHPI health, telehealth, and Medicaid policy to conduct advanced quantitative telehealth disparities assessment and (2) collaborate with Medicaid leadership and community-based organizations (CBOs) to disseminate findings to AIAN and NHPI communities, and their clinicians.

We analyzed 2019-21 Washington State Medicaid claims data to explore differences in telehealth use across race/ethnic groups. We also established and conducted AIAN and NHPI Community Advisory Board Meetings (between 2023-2024) with members from community-based organizations and Medicaid leadership to share results of analyses and discuss community experiences with telehealth.

We identified key trends in telehealth use during the COVID-19 pandemic including marked differences in the telehealth use between NHPI and non-Hispanic white Medicaid enrollees. We also identified key drivers of telehealth use including gender (female), preferring spoken English, chronic conditions, living in urban residence and managed care enrollment. Furthermore, we found these several of these key drivers had a different influence on telehealth use in each population. This points the importance of factors not observed in this study including cultural preferences, which warrant further investigation. There is the need to continue understanding and mitigating disparities in telehealth use as uptake continues to increase. Future efforts should consider approaches to increase access for these individuals who seek, but are unable to receive telehealth. It is important to engage community members throughout the research process to learn from community experiences.

Linking practice to policy change in urban community gardens

Investigators
Melanie Malone, UW Bothell (School of Interdisciplinary Arts & Sciences)
Natalie Garcia, Department of Medicinal Chemistry
Brittany Johnson, School of Environmental and Forest Sciences
Ray Williams, Black Farmers Collective
Neli Jasuja, Young Women Empowered
Em Piro, Sustainable Seattle

Project summary
This project sought to build on off four years of research that confirmed widespread contamination in urban community gardens (UCGs) throughout the Seattle metropolitan region, with the goal of expanding this research to center more community questions and to impact policy and testing of UCGs. As a result of this study, an article, “Uprooting Garden Contamination,” was published in the journal Environmental Science & Policy. The article detailed the environmental concerns farmers and gardeners in the Seattle metropolitan region have raised about contamination in urban gardens in the Seattle Metro region, and details systemic injustices contributing to the levels of contamination that have been documented. Another article, “A comparison of metal concentrations in vegetables from urban community gardens and groceries in response to community research,” is in review in the journal Environmental Health Perspectives.

The team’s recommendations for addressing contamination and improving soil health in urban community gardens have been included in the City of Seattle Food Action Plan, which is being compiled by various governmental departments in the City of Seattle, in collaboration with Tribal governments and feedback from community partners.

In addition, the King Conservation District has also started allowing for more expansive contaminant sampling at reduced costs for King County residents ($25 per sample) as a result of this work. Finally, numerous flyers, fact sheets and information sheets were created by graduate students, undergraduate students, and alumni researchers on the project. These materials have been shared with the broader public to keep people updated about the status of contamination in urban community gardens and to protect users of contaminated spaces.