Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Charlotte, NC 28207, USA.
BMC Public Health. 2012 Sep 11;12:769. doi: 10.1186/1471-2458-12-769.
Individual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants.
METHODS/DESIGN: This project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services.
The results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.
个人和社区健康受到弱势群体健康结果差异的不利影响。了解健康结果差异的根本原因是制定有效干预措施以改善不平等状况并最终改善整体社区健康的重要步骤。本研究从社区层面入手，研究了多种社会决定因素，这些因素可能导致健康不平等，包括社区财富水平低、社交网络薄弱、公共基础设施不足、社区内或附近存在有害物质以及缺乏初级保健服务。本研究的目的是开发创新且可复制的策略，以改善新到的西班牙裔移民等弱势社区的社区健康。
方法/设计：本项目在以社区为基础的参与性研究（CBPR）的主要原则为基础的基层医疗实践为基础的研究网络（PBRN）中进行。正在研究社会决定因素与住院率、急诊部（ED）使用以及 ED 用于初级保健可治疗或可预防疾病之间的关联。正在开发使用医院和社区层面数据的地理空间模型，以确定需要干预以改善差异的当地地区。使用社区调查和定性方法验证社会决定因素与健康结果之间以及地理空间模型的相关性。一个快速增长且服务不足的西班牙裔移民群体将成为干预的目标，该干预措施将根据研究过程来影响初级保健服务的利用，并且使用地理空间工具和定性研究结果来设计、部署和评估。该干预措施的目的是通过改善初级保健和预防服务的获取和利用来减少健康差异。
这项研究的结果将展示几种改善健康差异的新方法的重要性，包括使用 CBPR、利用社交网络影响健康结果的社区干预的有效性以及改善初级保健的重要性在改善健康差异方面。
