Asian Pandemic influenza community outreach (APICO) Program: Integrating Cultural and Linguistic Competence with Pandemic Influenza Preparedness

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Asian Pandemic influenza community outreach
(APICO) Program Integrating Cultural and
Linguistic Competence with Pandemic Influenza
Preparedness
APICO Program is made possible through funding
from the Illinois Department of Public Health

• By Jessica Szafron, BA and Hong Liu, PhD
• Midwest Asian Health Association

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Overview

• About MAHA
• Community Overview, Needs, and Partnership
  Model/Training Model
• Program Goals and Structure
• Program Training, Material, and Tools
• Outcome and Summary

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About Us
Who We Are
The Midwest Asian Health Association (MAHA) is a
community-based 501(c) (3) non-profit
organization located in Chicago South Chinatown.

Mission Statement
MAHAs mission is to reduce health disparities in
Asian American Pacific Islanders (AAPIs)
through providing culturally and linguistically
appropriate services and community outreach
including education, research, screening,
immunization, capacity building, and policy
advocacy.
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MAHA Community Health Center Month Health
Screening Clinic
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Breast and Cervical Cancer Program

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Life Smart for Chinese Women
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Hepatitis B and Liver Cancer Prevention Program
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Chinese American Mental Health Initiative (CAMHI)
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Chinese American Mental Health Initiative (CAMHI)
In November of 2010, we launched the first
Chinese American Mental Health Initiative with
over 70 Chinese organizations signing on in
supporting the Initiative
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All Kids Care Program

• Partner with the Mount Sinai Community Health
  Institute
• Working with Asian community based organizations
• Increase the enrollment of Asian kids in public
  aid

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Policy Advocacy Asian Executive Roundtable
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Policy Advocacy Hepatitis Campaign in Illinois
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World Hepatitis Day
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Research and Data Collection
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Survey Results Percent of Adults Ever Diagnosed
with Diabetes
US 7.5 (CDC, Behavior Risk Factor Surveillance
System, 2006)
Age-Adjusted Prevalence
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Asian Pandemic Influenza Community Outreach
Initiative
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Ten Year Population Change among Racial/Ethnic
Groups in Chicago (U.S. Census Bureau 1990-2000)
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Influenza Vaccination Rate among Different Groups
Influenza Vaccination in Previous 12 Months Influenza Vaccination in Previous 12 Months
Persons Aged 18-64 Persons Aged 18-64
Racial/Ethnic High Risk
Group ()
Non-Hispanic white 33.8
Non-Hispanic black 28.1
Hispanic or Latino 26.9
American Indian
Asian/Pacific Islanders 27.9
All groups 32.5
Numbers too small for meaningful analysis Numbers too small for meaningful analysis
National Health Interview Survey, 2004 National Health Interview Survey, 2004
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Asian Community Needs for Pandemic Emergency
Preparedness

• Lack of knowledge about the immunizations that
  are needed and how often to get them.
• Doubts that vaccines are effective in preventing
  illness and not believing they were at risk for a
  vaccine-preventable illness
• Fear of side effects and misconceptions about
  immunizations, particularly the myth that
  influenza vaccine can cause the flu.
• Lack of priority given to preventive health or
  forgetting about immunization,
• Distrust of healthcare providers.
• Lack of health insurance with limited access to
  healthcare and no usual source of care
• Cultural and language barriers to pandemic flu
  emergency information
• Lack of community infrastructure for emergency
  preparedness
• Lack of funding for programs and resources

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Asian Community Partnership Model

• Availability of bilingual assistance
• Cultural sensitivity
• Trusting relationship
• Convenience
• Recruitment strategy
• Availability of local media awareness

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Lay Health Advisor Model

• Bilingual with immigrant background
• Language and culturally competent
• Strong social network
• Respect and trust
• Skills and experience to deliver health messages

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Goal 1

• Goal 1 Build community awareness and
  infrastructure for pandemic influenza
  preparedness in the underserved Asian communities
  in suburban Cook County, DuPage County, Kane
  County, and Will County

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Objectives of Goal 1

• Objective 1.1 Create an Asian Coalition for
  Pandemic Influenza Response (ACPIR) and build a
  network and an infrastructure in the target
  communities
• Objective 1.2 Promote community awareness about
  pandemic influenza prevention and response and
  the Coalition through a media campaign
• Objective 1.3 Build a resource directory for
  pandemic influenza preparedness and collaborate
  in the target communities in the suburbs of
  Chicago

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Goal 2

• Goal 2 Improve community educational efforts for
  pandemic influenza education by developing and
  providing training to Lay Health Advisors and
  Peer Educators using culturally sensitive and
  scientific methods that address not only the
  risks, but also the barriers to immunization for
  the hard-to-reach populations with low English
  proficiency

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Objectives of Goal 2

• Objective 2.1 Develop language appropriate
  curricula for the seasonal and pandemic influenza
  training to Lay Health Advisors and Peer
  Educators
• Objective 2.2 Recruit the Lay Health Advisors
  (LHA) from each CBO and provide training to 25
  LHAs
• Objective 2.3 Recruit Peer Educators from each
  CBO who will be trained by the Lay Health
  Advisors (LHA) at each community site (total 125
  Peer Educators)

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Goal 3

• Goal 3 Provide program evaluation to assess the
  impact of the program and the Coalition, and
  develop strategies for program sustainability

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Objectives of Goal 3

• Objective 3.1 Establish a database for project
  progress and outcome evaluation
• Objective 3.2 Submit monthly report to IDPH
  Center for Minority Health for program feedback
• Objective 3.3 Search for future funding
  opportunities and submit grant proposal to
  sustain the Coalition and expand the education
  efforts to other Asian communities in Illinois

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Network Structure

• Public Health Departments
• Illinois Department of Public Health
• Cook County Department of Public Health
• DuPage County Health Department
• Kane County Health Department
• Will County Health Department

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Network Structure

• Community-Based Organizations
• Metropolitan Asian Family Services (MAFS)
• Xilin Association
• Chinese-American Association of Greater Chicago
  (CAAGC)
• Lao-American Organization of Elgin (LAOE)
• Hanul Family Alliance

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Network Structure

• Immunization Providers
• Public Health Department Immunization
  Coordinators
• Pharmaceutical distributers (Supervalu
  Pharmacies, etc.)
• Covers Albertsons, Jewel Osco, Shop n Save, Cub,
  etc.
• Vaccine For Children (VFC) Participants

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Training

• Train-the-trainer model
• Each CBO will identify 5 bilingual lay health
  advisors (LHA) and, in conjunction with MAHA
  staff, will provide pandemic influenza training
  to them at the community site
• 5 CBOs X 5 LHAs 25 lay health advisors trained

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Training

• Each LHA will each provide pandemic influenza
  training to 5 peer educators that are fluent in
  their respective languages under the guidance of
  the CBO
• 25 LHAs X 5 peer educators 125 peer educators
  trained
• Peer educators will work to educate their
  respective communities
• 25 LHAs 125 peer educators 150 people trained

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ACPIR Advisory Board Meetings

• April 21
• June 27
• August 23

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Media Promotion
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Media Promotion

• Xilin
• Mandarin PSA in Xilin Newsletter during week of
  June 22 and Xilins website shortly thereafter
• Hanul
• Korean PSA in KoreaDaily and KoreaTimes and
  newspaper article in KoreaDaily on April 26, 2011
• CAAGC
• Mandarin PSA sent to World Journal, Suncast TV,
  China Star Media, World Chinese Weekly, Sintao
  News, China Journal, Healthy Today, Chinese News
  Digest, ChicagoGuangzhou.com, and
  ChineseAmericanNews.com and promotion at
  Chinatown health fair
• LAOE
• Laotian PSA posed at Lao stores, Buddhist
  temples, and churches in the Elgin area
• MAFS
• Hindi and Gujrati PSA in Gujarat Darpan, Desitalk
  Chicago, and Sandesh Newspaper

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Media Promotion
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MAHA Lay Health Advisor Trainings

• May 5 18 LHAs trained by Jessica Szafron
• Metropolitan Asian Family Services (MAFS)
• Xilin Community Center (Xilin)
• Hanul Family Alliance (Hanul)
• May 9 2 LHAs from CAAGC trained by Jessica
  Szafron
• Chinese American Association of Greater Chicago
  (CAAGC)
• Lao-American Organization of Elgin (LAOE)

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MAHA Lay Health Advisor Trainings
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MAHA Lay Health Advisor Training
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CBO Trainings

• Xilin peer educator training- June 15

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Training Material

• What is influenza?
• Types of influenza
• Seasonal flu and its symptoms
• Pandemic flu what it is, severity, and examples
• Swine flu, Avian flu
• Antigenic shift of the virus
• Most at-risk populations
• Flu complications and prevention
• Vaccinations
• Flu treatment
• Planning responding to an outbreak

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Pre/Post Test
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Evaluation Results

• Standard Pre/Post Test with 20 questions was
  utilized in some trainings
• MAHA- 17.61 improvement rate
• 12.5 increase in points
• 71 83.5
• Xilin- 32.13 improvement rate
• 22.92 increase in points
• 71.33 94.25
• LAOE- 27.96 improvement rate
• 20.35 increase in points
• 72.78 93.13
• CAAGC- 25 improvement rate
• nearly 20 increase in points
• 80 nearly 100
• MAFS- N/A
• Hanul- N/A
• Test was translated in some cases

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CBO Trainings
Lay Health Advisors Peer Educators TOTAL
Hanul 10 16 26
LAOE 6 35 41
CAAGC 6 35 41
Xilin 10 60 70
MAFS 16 35 51
TOTAL 48 181 229
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Resource Directory
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Summary

• Established ACPIR advisory board
• Improved relationship between health
  departments, vaccination providers, and CBOs
• Strengthened network of community resources,
  assets, knowledge, skills
• Increased knowledge and awareness of pandemic
  influenza among CBOs and other stakeholders
• Increased provider understanding of barriers to
  vaccination among AAPIs
• Improved collaborations among Coalition members
• Improved commitment to Pandemic influenza
  prevention

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Summary

• Trained 229 LHAs and peer educators from across
  Indian, Chinese, Korean, and Laotian communities
• Improved knowledge among the target communities
  about education and immunization resources
• Increased awareness about flu immunization
• Reduced barrier to immunization
• Improved understanding of seasonal and pandemic
  influenza
• Improved knowledge about the system and
  preparedness
• Improved utilization of public resources

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Summary

• Released bilingual PSAs and press releases
• Culturally appropriate educational materials,
  flyers, evaluation tools developed to be used to
  effectively educate the target clients, program
  evaluation improved
• Increased media community awareness about
  Coalition and program messages.
• Created and utilized pre/post-test for training
  evaluation
• Outcome evaluation demonstrated improved clients
  knowledge and behavior change
• Improved impact of the program
• Identified challenges for improvement

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Summary

• Created resource directory
• Improved community infrastructure to address the
  disease

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Lessons Learned

• Lay Health Advisor model is an effective strategy
  to outreach to the hard-to-reach Asian,
  immigrant, LEP populations
• Translation of material increases community
  interest and involvement
• Establishing relationships between immigrant
  communities, CBOs, and health departments
  strengthens public health overall