Publications

As mentioned in Part 2, one public health program was a COVID-19 Project ECHO that was implemented in both English and Spanish and focused on increasing knowledge of COVID-19 and readiness to practice of COVID-19 health-related actions among CHWs across South Texas. In addition, the ST-AHEC program also implemented a CHW Health Equity Workgroup that focused on developing a COVID-19 Health Equity project that CHWs would present to their communities. As a program evaluation strategy, qualitative individual interviews were used to explore five CHW’s (from the ST-AHEC program team) perceptions of their participation in these COVID-19 public health projects as it relates to the Dimensions of Community Capacity. As mentioned previously, we will address the Dimensions of Social and Interorganizational Networks, Participation and Leadership, and Resources.

Gandara, E., Recto, P., Lesser, J., Zavala Idar, A., Zapata, J., Jr, Vela, V., Castilla, M., Hernandez, L., Escareño, J., Flores, M., & Morales, V. (2024). “Planting Seeds and Watching Them Grow”: Dimensions of Community Capacity Model and Cultural Competence (Part 3). Issues in mental health nursing, 45(7), 766–768. https://doi.org/10.1080/01612840.2024.2361332

As noted in Part 1, this column, Part 2, will focus on discussing the application of the Dimensions of Community Capacity through community engaged projects. These projects were focused on beginning to overcome the structural inequities exacerbated by the COVID-19 pandemic and were predominantly led by Community Health Workers (CHWs) who represented the communities they serve in South Texas.

Gandara, E., Recto, P., Lesser, J., Zavala Idar, A., Zapata, J., Jr, Vela, V., Castilla, M., Hernandez, L., Escareño, J., Flores, M., & Morales, V. (2024). “Planting Seeds and Watching Them Grow”: Dimensions of Community Capacity Model and Cultural Competence (Part 2). Issues in mental health nursing, 45(6), 654–657. https://doi.org/10.1080/01612840.2024.2350486

This mixed-methods study sought to examine the impact of the Project ECHO Brain Health program on participating community health workers’ (CHWs’) self-efficacy to address dementia, promote brain health, and advocate for research among Latinx South Texas communities. Using an explanatory sequential design, quantitative data collected from pre- and post-program surveys were analyzed to inform the collection of qualitative data, followed by an interpretation of all findings to better understand the impact of the program on self-efficacy. Pre- and post-surveys were collected from 25 CHWs, 13 of whom later participated in individual interviews. There was a statistically significant increase in mean self-efficacy scores between the pre- and post-surveys among participants. Three categories reflecting the experiences of participants were identified from the qualitative data: addressing training needs; impact on CHWs and their practice; and community of learning. The findings suggest that Project ECHO Brain Health program is a timely intervention that may facilitate increased self-efficacy among CHWs as they navigate the impacts of dementia in their communities.

Masoud, S., Escareño, J., Flores, B., Lesser, J., Choi, B., & White, C. (2024). Project ECHO Brain Health: Assessing the Impact of a Pilot Program to Promote Self-Efficacy Among Community Health Workers. Family & community health, 47(3), 191–201. https://doi.org/10.1097/FCH.0000000000000404

The purpose of this column is to reflect on the Dimensions of Community Capacity and note how these Dimensions align to and underscore the importance of Cultural Competence within community health. This will be the first of three columns, with column two and three focusing on the application of these Dimensions within projects co-led by Community Health Workers and the South Texas Area Health Education Center.

Gandara, E., Recto, P., Lesser, J., Zavala Idar, A., Zapata, J., Jr, Vela, V., Castilla, M., Hernandez, L., Escareno, J., Flores, M., & Morales, V. (2024). “Planting Seeds and Watching Them Grow”: Dimensions of Community Capacity Model and Cultural Competence (Part 1). Issues in mental health nursing, 45(5), 552–554. https://doi.org/10.1080/01612840.2024.2341036

Objective: To assess and examine how the COVID-19 pandemic may have impacted the mental health of a sample of health professions students (HPS) using an explanatory sequential mixed-methods design. Participants: Participants included 41 HPS enrolled in a co-curricular interprofessional education (IPE) program. Measurements: Measures included the CES-D scale, PSS scale, and the GAD scale. Qualitative description was used to explore the experiences of these HPS. Results: The HPS explained that fear of acquiring COVID-19, transmitting the virus to loved ones, and dying as a result of the disease negatively influenced their mental health. The HPS revealed that there were some beneficial outcomes resulting from the pandemic, including the strengthening of family bonds and the cultivation of resiliency. Conclusions: The pandemic has had a negative impact on the mental health of these HPS. It is essential that these students receive support for their mental health in order to provide optimal care to the population they serve.

Zapata, J., Jr, Zavala-Idar, A., Recto, P., & Lesser, J. (2024). The Mental Health Consequences of COVID-19 on a Sample of Health Professions Students: A Mixed Methods Study. Journal of American college health, 1–10. Advanced online publication. https://doi.org/10.1080/07448481.2024.2338425

Due to the COVID-19 pandemic and its aftermath, mounting evidence indicates that healthcare workers have suffered a deterioration in their mental health as a result of the COVID-19 pandemic, with studies reporting high prevalence rates of depression, anxiety, burnout, insomnia, and stress. Frontline workers have witnessed structural and social inequities that were exacerbated by the pandemic in their communities. Intertwined with these issues are feelings of isolation, work-related concerns, and loss of loved ones to COVID-19. Mental health interventions targeting the impact of the pandemic are critical to improve the mental health of healthcare workers, including community health workers (CHWs). CHWs are critical members of the public health workforce and the services they provide their clients address social and structural determinants of health and health inequities in their communities. With two-thirds of the population in South Texas identifying as Hispanic/Latino, the shared language and culture CHWs have with their clients allow them to fill a gap in culturally appropriate care that resonates with their communities. CHWs have a unique understanding of the experience, language, culture, and socioeconomic circumstances of their community members. This promotes connectedness with their communities, which is critical in building trust and developing relationships with their clients. Through these deep connections, CHWs have the capacity to empower their communities to make important changes by increasing knowledge and advocating for community strengths.

Recto, P., Lesser, J., Castilla, M., Escareno, J., Flores, M., Hernandez, L., Morales, V., Vela, V., Zapata, J., Jr, & Zavala-Idar, A. (2024). “It Felt Like a Trustable, Comfortable Circle”: Using CBPR Principles within a Culturally-Targeted Healing Program to Improve Mental Health. Issues in mental health nursing, 45(3), 356-359. https://doi.org/10.1080/01612840.2024.2321273

By not recognizing the number of predominantly Spanish speaking Community Health Workers, also known as Promotoras, in South Texas we are ignoring an important population. In a previous Cultural Competence Column, we highlighted the vital services that Community Health Workers (CHWs) provide including social support, health education, care coordination, navigation, and coaching, as well as advocating for their clients. They also have served as bridge figures, linking their clients with vital health care and public health services, which in turn can improve access to care and client health outcomes. CHWs in South Texas play an important role in improving the quality and cultural competence of how services are delivered because they often share ethnicity, language, socioeconomic status, and life experiences with the individuals that they serve in their communities.

Recto, P., Lesser, J., Castilla, M., Escareño, J., Flores, M., Hernandez, L., Morales, V., Vela, V., Zavala-Idar, A., & Zapata, J., Jr (2024). RED de Promotoras/es Del Sur de Tejas: “A Safe Place for Promotoras/es”. Issues in mental health nursing, 45(4), 440–443. https://doi.org/10.1080/01612840.2024.2316034

The purpose of this convergent mixed methods interprofessional education (IPE) pilot project was to help health profession students gain valuable insight about the experiences of people living with mental illness, to help them have a better understanding of person-centered care and have greater knowledge about the importance of interprofessional collaboration. A developmental workgroup which consisted of mental health consumers, four interdisciplinary students, and our team developed and implemented a virtual Mental Health World Café IPE event. Twelve other students attended the World Café event. A paired sample t-test was used to examine group differences between pre- and post-test scores for the Interprofessional Socialization and Valuing Scale and the Texas AHEC Survey measures among the four student leaders and the 12 student participants of the virtual Mental Health World Cafe. We conducted individual interviews with the four student leaders and collected reflective journals from the 12 students who attended the World Café event. We examined to what extent the statistically significant quantitative results supported the qualitative results separately for the student leaders and for the student participants of the virtual World Café. We also examined how both the quantitative and qualitative findings aligned with the key components of the Patient-Centered Care in Interprofessional Collaborative Practice Model. While the project allowed the students to reflect upon how they may apply the principles of person-centered care and interprofessional collaboration, the impact of the consumers on the student’s experiences was profound and resulted in widespread engagement of the students who attended the event.

Recto, P., Lesser, J., Paleo, J., Gray, A., Zapata, J., Jr, Zavala Idar, A., Castilla, M., & Gandara, M. (2023). Teaching Person-Centered Care and Interprofessional Collaboration Through a Virtual Mental Health World Café: A Mixed Methods IPE Pilot Project. Issues in mental health nursing, 44(8), 702-716. https://doi.org/10.1080/01612840.2023.2212780

Community Health Workers (CHWs) are trusted members of their communities who advocate on behalf of clients, interpret information to ensure that clients are connected to care, and serve as a vital intersection point between clients and their health care providers. CHWs have the capacity both to build individuals and empower communities to make meaningful changes by increasing health knowledge and advocating for existing community strengths with their deep community connections. As introduced in a former Cultural Competence Column, and based on principles of Community-Based Participatory Research (CBPR), a group of predominantly CHWs affiliated with the South Texas Area Health Education Center (ST-AHEC) Program co-developed and co-implemented a COVID-19 and Health Equity Project Extension for Community Healthcare Outcomes (ECHO) for CHWs and Promotoras/es. As noted in the literature, CBPR is an invaluable approach to any project development since this model guides both the community and academic partners to interconnect and move flexibly in their co-created project. In addition to CBPR principles, we chose to incorporate Freire’s Education Empowerment Pedagogy as its principles also promote the engagement of community members in the development of programs that seek to improve and reduce health disparities

Lesser, J., Castilla, M., Castillo, C., Escareno, J., Flores, M., Gandara, E., Hernandez, L., Morales, V., Recto, P., Vela, V., Zapata, J., Jr, Zavala-Idar, A. (2023). Developing a COVID-19 Health Equity Workgroup with CHWs: Answering a Call to Action. Issues in mental health nursing, 44(6), 571-575. https://doi.org/10.1080/01612840.2023.2218775

To examine how the COVID-19 Project ECHO program may have influenced the mental health of community health workers (CHWs) from South Texas. The program was designed around case-based learning and mentorship to provide support to CHWs and help them gain expertise to provide services to their communities. An explanatory sequential mixed methods pilot study. Fifteen CHWs who were enrolled in the program participated in this study. The Center for Epidemiological Studies-Depression (CES-D) and the Perceived Stress Scale (PSS) were used to measure the differences pre- and post-intervention. Qualitative description was used to explore the experiences of the participating CHWs. The PSS post-test mean (12.53) showed a statistically significant decrease from the pretest mean (17.01) (t (14 = 2.456, p = .028). The CHWs explained that the death of loved ones, feelings of isolation, and work-related concerns influenced their mental health. CHWs expressed that the program provided them with emotional support and resources for their clients. The impact of the COVID-19 pandemic on disadvantaged and medically underserved areas will be long-lasting; therefore, the need is greater than ever for CHWs to receive mental health support and be able to connect communities with vital resources.

Recto, P., Lesser, J., Zapata, J., Jr, Gandara, E., Idar, A. Z., & Castilla, M. (2022). Supporting Community Health Workers During the COVID-19 Pandemic: A Mixed Methods Pilot Study. Public health nursing, 40(1), 63-72. https://doi.org/10.1111/phn.13144