Publications

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 Jr., J., 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, DOI: 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., & 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.

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.H., Zapata Jr., J., A., 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.

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., 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.

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., Gandara, E., Idar, A. Z., & Castilla, M. (2023). Supporting Community Health Workers During the COVID-19 Pandemic: A Mixed Methods Pilot Study. Public health nursing; 40(1), 63-72.

Substance use disorders (SUDs), like opioid use disorder (OUD) have had a significant impact on communities across the U.S. In 2018, an estimated two million people were reported to have an opioid use disorder in the U.S. Within the State of Texas, opioid-involved overdose deaths totaled 1402 in 2019, with Latinos making up 25% of opioid overdose-related deaths. Within the literature, several sociocultural factors have been associated with limited access to services for opioid misuse within the Latino community. Language barriers are often one of the largest issues related to prevention, treatment, and recovery strategies for Latinos regarding the opioid crisis; demonstrating the need for more bilingual providers and program materials available in participants' native language. Within the literature, Community Health Workers (CHWs) have been shown to be effective across multiple settings and health issues. In order to tackle OUD in South Texas, the ST-AHEC team decided to adopt an existing OUD program for CHWs, the CHW-OUD Project ECHO Program developed by UNM. In order to translate our English CHW-OUD ECHO program into Spanish, a Spanish-language CHW-OUD workgroup was created that was made up predominantly of CHWs. This workgroup used a participatory approach to translate our existing English CHW-OUD Project ECHO curriculum into Spanish. This Spanish language CHW-OUD ECHO program that was developed is important as it targets many of the socio-cultural barriers noted in the literature that influence access to opioid services for Latinos. In addition, it meets the community-informed strategies that SAMHSA has stated are needed to address opioid misuse in Latino communities.

Gandara, E., Recto, P., Zapata, J., Moreno-Vasquez, A., Idar, A. Z., Castilla, M., Hernández, L., Flores, M., Escareño, J., Castillo, C., Morales, V., Medellin, H., Vega, B., Hoffman, B., González, M., & Lesser, J. (2023). Reducing opioid use disorder health inequities within Latino communities in South Texas. Public health nursing; 40(1), 163-166.

This scoping review will identify, characterize, and classify co-curricular interprofessional education activities and practices. According to the World Health Organization, interprofessional education occurs when students from two or more professions learn about, from, and with one another to enable effective collaboration and improve health outcomes. As such, interprofessional education is imperative to health professions education. Globally, competency frameworks and guidelines have urged educators to reach consensus about interprofessional education terminology and to integrate this form of education into formal curricula. Voluntary interprofessional education that takes place outside formal curricula (ie, co-curricular) is frequently used to overcome well-documented barriers (eg, discordant academic calendars). We will explore the global literature to identify, characterize, and classify published examples of co-curricular interprofessional education activities. This review will consider voluntary interprofessional education involving students from at least two different health professions. These education activities will take place outside the formal curriculum and will not result in transcript designation. The search strategy will aim to locate primary studies from peer-reviewed journals indexed in MEDLINE, CINAHL, Scopus, ERIC, and Academic Search Complete. The results will be limited to English-language publications from 2009 until the present. Two independent reviewers will screen titles and abstracts, and potentially relevant papers will be assessed in detail. Data will be extracted using a tool developed by the reviewers. Descriptive statistics will be used to characterize the data, which will be presented in diagrammatic, tabular, or other relevant formats.

Lesser, J., Farokhi, M. R., Lacy, J., Chapa, I., Garcia, S., Geelhoed, M., Johnson, L., Stone, M., Worabo, H., & Zorek, J. A. (2022). Defining and classifying co-curricular interprofessional education in the health professions: a scoping review protocol. JBI evidence synthesis; 20(7), 1842-1851.

Our belief is that health profession students can best learn about the principles of person-centered mental health care from the experiences of people living with serious mental illness. Person-centered care, also referred to as patient-centered care, is an approach that emphasizes and respects the values, beliefs, and hopes of individuals. Previously published literature has shown the positive influence of teaching recovery and person-centered care by people living with serious mental illness to health profession students. Byrne et al. (2013) found that teaching mental health recovery from the lived experience perspective helped nursing students gain a better understanding of what it means to live with mental illness, and the importance of providing holistic, person-centered care. Additionally, they learned that people living with serious mental illness are able to live fruitful, productive lives and that recovery from mental illness was possible. Being taught by a person with lived experiences during their education and training teaches students to see individuals as a person beyond their illness, and the importance of collaborating with them about their own care.

Recto, P., Lesser, J., Paleo, J., Gray, A. H., Zapata, J., Idar, A. Z., Castilla, M., & Moreno-Vasquez, A. (2022). The Co-Development and Implementation of a Mental Health World Cafe. Issues in mental health nursing; 44(4), 338-342.

Community health workers (CHWs) are frontline public health workers who are trusted members of the community they serve. CHWs often serve as connectors between social services, healthcare, and the community in order to help increase access to services to members in the community. Moreover, CHWs play an important role in improving the quality and cultural competence of how services are delivered. This is because CHWs often share ethnicity, language, socioeconomic status, and life experiences with the individuals that they serve in their communities. Moreover, CHWs often reside in the community they serve and are to able take information with them where it is needed most. In addition, CHWs are noted as agents of change in helping to reduce health disparities within underserved communities.

Gandara, E., Recto, P., Zapata, J., Jr, Moreno-Vasquez, A., Zavala Idar, A., Castilla, M., Hernández, L., Flores, M., Escareño, J., Castillo, C., Morales, V., Medellin, H., Vega, B., Hoffman, B., González, M., & Lesser, J. (2022). Using CBPR Principles with CHWs to Translate an English to Spanish Language CHW COVID-19 & Health Inequities Project ECHO within South Texas. Issues in mental health nursing; 44(3), 218-222.

To date, Texas has had over 4 million cases of infections and more than 74,000 deaths from the novel coronavirus disease (COVID-19). The COVID-19 pandemic has exposed frontline healthcare workers to unprecedented situations thereby causing them to experience psychological distress and burnout. The ever-increasing number of confirmed and suspected cases, overwhelming workload, understaffed personnel, risk of exposure to the infection, as well as feelings of isolation due to social distancing measures are contributing to high rates of depression, anxiety, post-traumatic stress, and insomnia to frontline healthcare workers. Much of the research and the literature we found about the mental health of frontline healthcare workers during the COVID-19 pandemic were focused on nurses, physicians, and first responders. Research involving other frontline healthcare workers such as CHWs is largely absent. Although a growing body of literature exists, the need to better understand the mental health consequences of the COVID-19 pandemic as a whole on frontline healthcare workers, including CHWs, is indicated. Doing so could result in the development of effective programs that can deliver mental health support to all frontline healthcare workers, including CHWs.

Recto, P., Zapata, J., Gandara, E., Moreno-Vasquez, A., Zavala Idar, A., Castilla, M., Hernandez, L., Flores, M., Escareno, J., Castillo, C., Morales, V., & Lesser, J. (2022). The Vital Role of CHWs During the COVID-19 Pandemic within the South Texas Communities. Issues in mental health nursing; 43(9), 878-881.