Community engaged research to measure the impact of COVID-19 on vulnerable community member’s well-being and health

Study setting and design

We used the priority health domains from the most recent CHNA reports to identify topic areas previously prioritized by local community and public health departments in the three counties in which our system has a primary presence. We met with CHNA teams, including internal public engagement staff and members of local departments of health, to assess the status of the CHNA process in each region, coordinate content, and attempt to avoid any duplication of effort. These meetings continued through the course of the initiative.

After synthesis, the four combined domains we identified were access to care, maternal/child health, obesity/food security/physical activity, and addiction and mental health. Based on our review of the CHNA reports, which focused on general findings during non-COVID times about the general catchment area population, we believed a more detailed understanding of the specific needs of vulnerable populations was warranted to provide guidance for action on health equity. We considered our study a “deeper dive” into identified issues of concern.

Data collection occurred between March and November of 2021. We conducted a multi-site healthcare system-wide initiative engaging with communities within the catchments areas of the three largest hospitals of Mayo Clinic as well as the Mayo Clinic healthcare system. Mayo Clinic tertiary care academic medical centers are located in Rochester, (MN) Jacksonville, (FL) and Scottsdale, (AZ). The healthcare system spans several states including Minnesota and Wisconsin.

The study employed mixed quantitative and qualitative methods in three phases. Phase 1 involved qualitative key informant interviews, phase 2 involved focus groups and phase 3 employed an anonymous, online survey. The qualitative phases of the study were approved as minimal risk by the Mayo Clinic institutional review board (IRB). The quantitative phase was conducted entirely by an external, professional survey research company. As verified by research compliance, Mayo Clinic had no participant contact, was therefore not engaged in human subject research, and this phase was not eligible for IRB review.

Phase 1: key informant (KI) interviewsParticipants and recruitment

We used purposive sampling to identify key informants (KI) from multiple stakeholder groups including county public health officials, safety net medical providers, community leaders, non-profit organization executives and staff, and health system leadership. Individuals were asked to participate based on the likelihood that they would have useful insights for our study and were often suggested by our public engagement leaders who spearhead the CHNA. We reached out to stakeholders via email or telephone to outline the nature of the study and participation requirements. Consent forms were automatically emailed to those who agreed to participate and completed via DocuSign (DocuSign, San Francisco, CA, USA) prior to the interview [22]. We interviewed 24 KIs.

Interview guide

The interview guide was developed by the broader study team and included questions that explored the mission of the organization within which the KI was working, the communities the organization served, the health challenges facing those communities, current efforts to address the needs and assets, and research needed to amplify current work. Other questions explored the specific effect of COVID-19 in those communities, how services were modified to meet needs, and suggestions for efforts and research to support and prepare communities for future similar events as well as the organization’s relationship with local health institutions and current collaborative initiatives.

Data collection

Following consent, study team members conducted one-on-one, semi-structured interviews. Interviews were scheduled for up to 60 min and were conducted via online video conferencing [23]. Interviews lasted 30–40 min in general. Financial remuneration was not deemed appropriate by the study team and the IRB concurred.

Key informant qualitative analysis

All KI interviews were digitally recorded. Audio recordings were transcribed verbatim by a HIPAA-concordant professional transcription firm and de-identified prior to analysis.

Interview data were organized and analyzed using the framework analytic approach [24]. This accessible and efficient approach was chosen for several reasons. Some members of our research team were experienced qualitative researchers, and others were less experienced. Under the leadership of our experienced coders the framework method provided a systematic and flexible approach to analyzing our data. The index paraphrasing is readily auditable allowing any research team member to participate in sense-making of the large dataset. Additionally, given the multidisciplinary nature of our study team the framework approach provided a helpful structure for cross-disciplinary analysis using matrices we developed.

For the KI qualitative phase, coders collaborated on each phase of analysis from initial content paraphrasing and indexing to codebook development and exemplar (quote) retrieval.

Phase 2: focus groupsParticipants and recruitment

We conducted focus groups (FGs) with individuals in all three regions who represented different residential, professional, and social communities. We distributed flyers in Spanish and English through social media and community organizations. The purpose of the study, risks and benefits, and the option to decline any question and/or withdraw at any time were outlined to participants before scheduling. In addition, we worked collaboratively with local departments of health who were conducting focus groups with similar topic areas for their own purposes. Ultimately, our group conducted 16 focus groups and negotiated for data sharing of 31 more.

Moderator guide for focus groups

The moderator guide was developed by the broader study team and community partners and included questions about hopes following COVID-19, the impact of COVID-19 on access and use of health care, the personal impact of COVID-19 on other aspects of life, how COVID-19 affected vulnerable communities and the availability of resources and potential assets need to support those communities, as well as thoughts about the vaccine.

Data collection

The FGs were scheduled for and lasted approximately 60 min and were conducted via either online videoconference or in person (for participant communities that lacked broadband access), audio-recorded, de-identified, and transcribed. The moderator began the activity by outlining the elements of consent which had been shared prior to scheduling with participants and they were asked to confirm consent verbally. To the greatest extent possible, ethnically, and racially congruent moderators were used in FGs and two were conducted by bilingual moderators in Spanish. Participants received a modest amount of remuneration.

Focus group qualitative analysis

All FGs were digitally recorded, and the audio recordings were transcribed verbatim by a HIPAA-concordant professional transcription firm and de-identified prior to analysis. The FGs conducted in Spanish were professionally transcribed and translated by a licensed medical translator. Data from FGs conducted by our team and those conducted by others were stored and analyzed in parallel using identical coding structures but were not combined into one dataset.

As with the KI data, FG data were organized and analyzed using the framework analytic approach, although the two datasets were analyzed separately [24]. For this qualitative phase, two trained coders collaborated on each phase of analysis from initial content paraphrasing and indexing to codebook development and exemplar (quote) retrieval. Coding was guided deductively by CHNA domains, as well as the moderators’ guide built around those constructs. Coding was also left open to inductive findings as they arose during the coding process.

Phase 3: survey

A community survey was developed to assess stressors, resources, well-being, and health care access and outcomes associated with the COVID-19 pandemic. The survey was fielded through organizations serving the communities surrounding Mayo Clinic in Minnesota, Wisconsin, Florida, and Arizona. These organizations were those that had worked with the healthcare system in previous CEnR or through outreach efforts.

Survey instrument

The survey was developed with the input of community and scientific leaders and stakeholders. First, relevant constructs were selected based on a scan of the scientific literature around stress and resilience, disaster recovery, and COVID-19. The construct list was augmented with input from key stakeholders in the Mayo Clinic Center for Health Equity and Community Engaged Research (CHCR), the Mayo Clinic Comprehensive Cancer Center, and three community advisory boards (CAB). Measures representing relevant constructs were selected from published literature based on published construct and predictive validity and reliability. Measures with face-validity were created by the study team when no appropriate scale could be located. Some scales were shortened to reduce respondent burden by selecting items with highest factor loadings or item-scale correlations or based on study team evaluation of content if psychometric properties were unpublished. Consideration was also given to ensuring subscales were represented by multiple items. Survey measures assessed facets of COVID-19 testing, vaccination and strategies adopted to mitigate the risk of infection as well as resilience, coping, isolation, community, and support. The survey also explored the impact of COVID-19 on medical care, ability to access healthy food and physical activity, physical and mental health, and opinions about telehealth and clinical trials. The survey was extensively pilot tested and we solicited comments and suggestions from CABs, existing panels of research scientists and broader panels of community engagement researchers across the institutions and volunteers [25]. The survey was also translated into Spanish by a licensed medical translator and tested by bilingual English-Spanish speakers.

Participants and sampling strategy

The survey link was disseminated through existing networks of community partners and health ministries including social media and email lists for a period of 8 weeks in summer and fall of 2021. Recruitment material also included advertisements in community gathering locations. We contracted a professional research firm to host, accrue, and de-identify data. Participants who completed the survey had the option to receive a small financial remuneration via email.

Data analysis plan

Raw data were “cleaned” using standard practices including humanistic and heuristic approaches that involve inclusion of survey completion time, originating IP address, assessment of correlated variables and plausible associations, and attention-check item response, to reduce the likelihood of including fraudulent or duplicate responses [26]. Analysis is underway and has consisted of three phases: 1) exploratory factor analyses to ensure scale items load to their intended scales, including calculation and reporting of psychometric properties, 2) univariate descriptive analyses, including calculating means, standard deviations and scale and item distributions and weighing sample analyses appropriately to represent population estimates for the three geographic regions and 3) bivariate and multivariate models to examine relationships between variables. As we leveraged social media for disseminating the survey, we have no mean of calculating the response rate; however, we can report that after data cleaning the completed dataset included 3445 English language responses and 146 Spanish language responses. Responses are proportionate to the geographic population of the area surveyed.

留言 (0)

沒有登入
gif