Abstract
Introduction
Healthy Start is an initiative to reduce infant mortality and improve birth equity throughout the US, in large part by deploying community health workers (CHWs) to conduct home visits and provide educational and emotional support to new and expectant parents.
Methods
A mixed-methods assessment of the Bronx Healthy Start Partnership (BxHSP) was conducted as part of a quality improvement initiative to understand client perspectives regarding the impact of BxHSP on short- and intermediate-term outcomes that affect long-term well-being. Phone interviews (n = 16) and online surveys (n = 62) were conducted in English and Spanish with BxHSP participants in 2020 and 2022. The interview sample was selected purposefully; interview participants were eligible if they gave birth prior to mid-March 2020 and had received at least one CHW home visit. All individuals with open BxHSP cases (n = 379) were invited to complete the survey.
Results
Findings suggest that BxHSP CHWs can provide vital psychosocial, material, and educational resources that help engaged participants feel supported as new parents and develop knowledge and skills related to infant care. Results further suggest that these short-term outcomes contribute to lower stress, increased self-efficacy, and health-promoting infant care practices, enabling participants to feel more confident and capable as new parents.
Discussion
Findings underscore how programs like BxHSP can help address gaps in resources and improve health and well-being for pregnant and postpartum participants. Limitations include possible selection, recall, and/or social desirability biases as response rates were low and data were self-reported and retrospective. Limitations were addressed in part through triangulation of qualitative and quantitative data.
Abstract
The COVID-19 pandemic and its related economic challenges exacerbated food insecurity across New York State (NYS). Approximately one third of New York City residents reported use of emergency food services in the pandemic’s first year and, in 2021, approximately 1 in 10 NYS residents was food insecure, with rates among Hispanic and Black New Yorkers more than double that of White residents. Although these numbers have decreased following the acute phase of the pandemic, disparities by race and ethnicity persist and use of emergency food services remain elevated for New Yorkers born outside of the United States. Despite this, few policies and interventions that aim to improve the charitable and emergency food systems focus on the cultural relevance and appropriateness of foods provided. In 2022, researchers conducted 12 interviews with key stakeholders from organizations and institutions providing food distribution services to culturally diverse New Yorkers to understand barriers and facilitators related to providing culturally appropriate foods and elicit lessons learned and recommendations to inform future programs and policies. Findings from this study indicate that organizations serving diverse communities recognize the importance of providing culturally appropriate food services and make efforts to tailor these services accordingly. However, they face challenges that limit their capacity to offer foods consistent with the dietary needs and preferences of their clients. Additional funding, policies, and support are needed to improve the availability of culturally inclusive food distribution services within the emergency and charitable food systems.
Related Publications
Abstract
Objective:This study focuses on barriers to Supplemental Nutrition Assistance Program (SNAP) enrollment and retention for Latine immigrant families in New York City and the value of facilitated access to SNAP provided by community-based organizations (CBOs).
Methods: Between 2021 and 2023, we conducted surveys and interviews with Latine parents of children under 18 who received SNAP-related assistance from a CBO in the past year (250 surveys, 15 interviews). We also conducted interviews with staff from this same CBO (3 interviews with 6 participants).
Results: Findings underscore the importance of SNAP to immigrant families with low incomes, the specific challenges immigrant families face in accessing the program, and the value of CBOs in facilitating access to SNAP for these families – by providing information, instilling trust, and addressing administrative burdens.
Conclusions: Current SNAP enrollment and recertification processes create access barriers for eligible immigrants. Potential policy approaches to increase access include adjustments to documentation requirements, including reducing reliance on third parties; coordinated enrollment across benefit programs; improving language services; clarifying eligibility requirements that may cause fear among immigrants; and providing consistent and sufficient funding to CBOs facilitating access.
Abstract
Patient race/ethnicity data collection in most U.S. health systems abide by federal standards, determined by the federal Office of Management and Budget. Yet, decades of research show that reliance on these categories alone limits understanding of within-group health disparities, systematically erasing key groups from health data. Because granular race/ethnicity data is complex and patients may be hesitant to disclose this personal information, it is important for health leaders to consider community perspectives when making decisions about race/ethnicity data procedures. As such, this study uses community focus groups to understand: (1) how individuals representing different racial/ethnic identities perceive the collection of race/ethnicity in healthcare settings; (2) differences in opinions between disaggregated race/ethnicity data collection instruments and those using federal standards; and (3) recommended practices for collecting race/ethnicity from patients. Participants self-selected into 13 focus groups and one key informant interview based on the race/ethnicity with which they most closely identified. Audio recordings from these groups were transcribed and evaluated using thematic content analysis. Among the 83 total participants in this study, there was a strong preference for more flexible and specific options for self-identifying race/ethnicity in healthcare settings. Participants also felt comfortable disclosing granular race/ethnicity to health providers but expressed discomfort with disclosing this information for other purposes. Recommendations for healthcare leaders include ensuring patients receive detailed communication about race/ethnicity data use and purpose, allowing multiple category selection, keeping the list of disaggregated response options short so as to not overwhelm patients, and providing a free text option to ensure inclusivity.
Community-based organizations (CBOs) are crucial institutions within immigrant communities, providing a variety of supports that ease the transition into a new land, including concrete services focused on health, education, housing, financial security, and language access; facilitation of social support and community connections; and mobilization and advocacy to promote civic engagement and community well-being.1, 2 CBOs, including those serving low-income immigrant communities, also provide outreach, navigation, and facilitated enrollment into benefit programs, assisting community members in accessing vital programs and services to which they are entitled.3 Benefit programs often come with complex regulations and requirements, including the provision of documentation, which exacts a toll on applicants and may delay or restrict access, even to those who are eligible.3–5 For low-income immigrants, these challenges are commonly exacerbated by limited English language skills, lack of familiarity with benefit programs,6 and fear of legal consequences related to their immigration status.
The study described here was conducted between 2021 and 2023, and focuses on administration of, and facilitated access to, benefit programs provided by Make the Road New York (MRNY), a community-based organization that builds the power of Latine and other immigrant and working-class communities across NYC and surrounding counties through an array of health, education, legal, and survival services, as well as community organizing and advocacy at the local, state, and federal levels.