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Changing Health Outcomes for Minorities

Monday, April 17, 2017

April is National Minority Health Month, a time to raise awareness on issues impacting health disparities and health equity in America.

Health disparities, a difference in health and well-being, have a significant impact among racial and ethnic populations in particular. According to the U.S. Department of Health and Human Services Office of Minority Health, deaths that result from health disparities cost the United States $1.24 trillion.

Duke University School of Nursing (DUSON) is strategically committed to collaborating with the community to advance health, including reducing health inequities and disparities in the community through practice, education and research.

Faculty members Rosa Gonzalez-Guarda, PhD, MPH, RN, CPH, FAAN, associate professor with the Division of Healthcare in Adult Populations for DUSON and faculty lead for the Population Health and Chronic Illness research area of excellence core for the DUSON Center for Nursing Research, and Paula Tanabe, PhD, MSN, MPH, RN, FAEN, FAAN, associate professor for DUSON, along with Doctor of Nursing Practice (DNP) student Terrye Moore-Harper, MSN, RN, ACNS-BC, CNL, and PhD student Deanna Befus, BSN, RN, share their work in improving health outcomes for minority populations.

Intimate Partner Violence, HIV and Mental Health in the Hispanic Community

Rosa Gonzalez-Guarda’s research seeks to understand the intersection of intimate partner violence, HIV and mental health among Hispanics in the United States and to address health disparities experienced by this group through culturally tailored interventions. Her passion for working with the Hispanic/Latino population started when she was in high school.

“I started doing community work in the Dominican Republic more than 20 years ago,” said Gonzalez-Guarda. “While there, I observed very poor social and environmental conditions that influenced the health and well-being of the community. I felt guilty that just because I was born in Miami, Florida, versus San Pedro De Macoris, Dominican Republic, I had the privilege of enjoying better social and health conditions.”

Gonzalez-Guarda wanted to learn how she could change these injustices. She began working with public health nurses who were already addressing these disparities. And from there her love for public health and health disparities was born.

Her current work focuses on preventing risky behaviors such as unprotected sex, violence and substance abuse among Hispanic/Latino communities and the consequences of such behavior. “I have learned from community partners and research participants that acculturation related stress plays a major role in influencing risk behaviors, resilience and health outcomes, such as depression, among this community,” she said.

Gonzalez-Guarda said that research has yet to determine how these stressors influence physical health and what types of stressors – immigration versus cultural stress – are most detrimental. “By learning what types of stressors are most detrimental among the Hispanic/Latino community and what other resilience factors protect them, we will be able to develop interventions that are more precise in addressing the most detrimental stressors while at the same time building on strengths of the community.”

Sickle Cell Disease

Paula Tanabe has spent more than 10 years focusing on improving systems of health care and patient outcomes for persons with sickle cell disease (SCD), primarily a minority and under-served population. “I began my work as a researcher when pain was poorly treated for all patients in the emergency department,” she said. “Over the years, as we began to better manage pain in the emergency department (ED), it was clear we were still not managing pain for patients with sickle cell disease.”

Tanabe saw that there were so many barriers to improving care and treatment of SCD patients beyond the ED, and she shifted her focus to improving the health care system and processes for patients with SCD (both inside and outside the emergency department).

Her current research disseminates decision support tools to primary care and emergency department providers throughout North Carolina and portions of South Carolina. The tools are based on the National Heart, Lung and Blood Institute (NHLBI) evidence-based recommendations for the treatment of SCD and aim to assist ED providers and primary care providers (PCP) in the treatment of SCD. In addition, she is also the co-principal investigator for the NHLBI “Sickle Cell Disease Implementation Consortium, U01.” The consortium includes eight centers from across the United States that will conduct a comprehensive assessment of barrier to care from the perspectives of patients and health care providers.

“The work done by our team will improve the likelihood that patients with SCD will receive excellent pain management and care when they need it in any ED in North Carolina and parts of South Carolina,” said Tanabe. “It will also increase the likelihood that patients with SCD will be able to obtain primary care from a PCP and a sickle cell specialist. Better access to providers will ultimately lead to better health and improved quality of life.”

Diabetes Care in the African American Community

In addition to being a doctoral student, Terrye Moore-Harper also works as an assistant professor in the School of Nursing at Touro University – California in Vallejo, California. She has spent more than 20 years educating populations at risk for diabetes and its complications. “My goal has always been to educate and equip populations affected by diabetes and to reduce the incidence of developing the disease or to improve the management of the disease through self-care behaviors.”

Her passion is fueled by both a personal and professional experience. Moore-Harper’s father was 50 years old when he died of diabetes-related complications. “I observed his 15-year struggle with the burden of this disease,” she said. “If he were alive today, I believe he would join me in this fight to educate and equip the African American population to improve their health outcomes and life expectancy.”

Her professional focus is on diabetes awareness and education in the African American community and its relation to health disparities resulting from social determinants like economic inequalities, resource depletion and geography. Between 2016 and 2017, Moore-Harper launched a 12-week, three-prong “Diabetes Awareness and Education Program” that integrated aspects of faith, such as prayer and scripture reading, with diabetes-specific education and peer-support.

“Faith-based programs incorporating spiritual components and social support are shown to have positive effects in developing self-care behaviors and peer accountability in this population setting as well,” said Moore-Harper. “The three-prong approach of my program was aimed at improving participants’ self-efficacy of self-care behaviors through diabetes education tailored to meet their specific needs.”

During the program, she solicited the help of several health professionals within her church to ensure that the program achieved its objective. For Moore-Harper, it was important for her to have an impact in the community where she lived and worshipped.

Managing Migraines for Low Income Women

Prior to becoming a PhD student at Duke, Deanna Befus worked as a public health nurse in a “safety net” clinic that consists of an array of providers delivering a broad range of health care services to medically underserved and uninsured populations. Issues of social justice have always been at the root of her work even before she became a nurse and had a special interest in women’s health.

“My reason for getting up in the morning is to try and unmask how systems of power – social, economic, political, historical, etc. – privilege some groups while oppressing others,” Befus said. “In my current research, I’m exploring how women in low social positions manage migraine pain and disability.”

According to Befus’s research, women of color who are living in poverty have significantly higher levels of pain and disability from migraine yet are virtually invisible in the research. “I hope to learn more about systemic factors that affect their abilities to achieve their best possible health,” she said.

Befus is interested in the experiences of socially-marginalized women living with invisible chronic pain due to systems, such as sexism and racism, influencing how their experiences are viewed and judged by the health care system.

“Migraines are an ideal example because women are often dismissed as being dramatic or being lazy because it’s not considered a legitimate pain,” said Befus. “However, it’s the third most disabling condition in the world! I think one of the best ways I can support marginalized women with pain is to critically examine and shape the systems that unfairly disadvantage them.”

Befus said that a colleague of hers once joked that she looks at everything through a lens of power: asking where it is, who has it, who doesn’t, what it’s being used for? And she agrees. She said it’s her responsibility as a new researcher, nurse, community member and Caucasian woman to recognize and name the unearned benefits she has and then partner with others to create systems that are more equitable and just.

The Duke University School of Nursing celebrates the diversity of work from our faculty, staff and students. We will continue to profile these researchers and more. Keep up with our news by following us on Facebook and bookmarking nursing.duke.edu.