Eliminating Health Disparities within Minnesota

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Eliminating Health Disparities within Minnesotas
Somali Refugee Population A Community-based
Approach
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• Nathaly Herrel, MSc1, Diana DuBois, MPH/MIA2,
  Saeed Fahia, PhD3, Qamar Ibrahim, MS4, Khadija
  Sheikh5, Faduma Abdi6, Mahmooda Khaliq, MHS7
• 1. Project Coordinator, Somali Health Care
  Initiative, Minnesota International Health
  Volunteers (MIHV)
• 2. Executive Director, Minnesota International
  Volunteers (MIHV)
• 3. Executive Director, Confederation of Somali
  Community in Minnesota (CSCM)
• 4. Executive Director, Leadership, Empowerment,
  and Development Group (LEAD)
• 5. Community Health Worker, Somali Health Care
  Initiative, MIHV
• 6. Community Health Worker, CSCM
• 7. Program Specialist, MIHV

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Abstract
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• Minnesota is home to over half of all Somali
  refugees in the US, with population estimates
  ranging from 10,000 to 60,000. Although
  Minnesota prides itself on being one of the
  healthiest states in the nation, there are still
  very large health disparities that persist within
  immigrant and refugee communities.
• There are numerous challenges Somali refugees
  face including
• Accessing health care
• Language and cultural barriers
• lack of health insurance
• unfamiliarity with the US health care system
• Minnesotas health care providers also face
  challenges when trying to provide
  culturally-appropriate quality health care for
  their Somali patients. To bridge the health gap
  that persists between the Somali community and
  other Minnesotans, Minnesota International Health
  Volunteers successfully launched the Somali
  Health Care Initiative (SHCI) in March 2002 in
  partnership with two African organizations
  Confederation of Somali Community in Minnesota
  and the Leadership, Empowerment and Development
  group.

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• The SHCI addresses the six health disparity areas
  stated in Healthy People 2010
• breast and cervical cancer
• diabetes
• cardiovascular disease
• infant mortality
• HIV/AIDS
• immunizations
• Key activities of the SHCI include
• Training of Community Health Workers
• Somali community health forums
• cultural competency conferences for health
  providers
• community-based health survey

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Background
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(No Transcript)
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Minnesota is home to the largest community of
Somalis outside of East Africa. Community
estimates range from between 10,000 and 60,000
Somali people living in Minnesota with a majority
residing in the Twin Cities. The Somali
community in Minnesota has had to face many
challenges while adapting to life in the Twin
Cities one of these being accessing the health
care system. There are many stark contrasts
between the health care systems of Somalia and
the US, which can make access to preventative
services and treatment difficult. The agencies of
the SHCI recognized the need to bridge this
health disparity gap. The Somali Health Care
Initiative (SHCI) is funded through the
Eliminating Health Disparities Initiative of the
MDH and Blue Cross Blue Shield Foundation of
Minnesota.
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The objectives of the SHCI are

• To increase cultural competence of providers who
  work with Somali patients.
• To increase knowledge in the Somali community
  around specific health issues and to improve
  overall access to health care.
• To increase health data about the Somali
  community through community-participatory
  research (e.g. - Somali Health Survey).
• To map Somali community assets.
• To build health care capacity within the Somali
  community by forming a cadre of Community Health
  Workers.
• To share resources and materials with health
  providers, the Somali community, and relevant
  agencies throughout Minnesota to increase overall
  awareness of Somali health disparities.

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Approach
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• The SHCI has planned and implemented activities
  using a participatory process
• Weekly partner meetings
• Because the SHCI is a collaborative partnership
  between three agencies the input of all partners
  is critical during the decision-making process.
  A collaboration charter, which outlines the
  partnership vision, values, and roles guides the
  work of the partners.
• Formed an advisory committee
• An advisory committee of key Somali leaders and
  health professionals help to evaluate the
  appropriateness and effectiveness of SHCI health
  programs. The partners and advisory committee
  meet to discuss program activities at the outset
  and the conclusion of the project.
• Performed Somali community asset mapping
  exercise
• There are many resources that have been
  identified in the Somali community as a result of
  the asset mapping exercise. In addition to the
  formation of the advisory committee, holding
  meetings with Somali community organizations and
  identifying key Somali media and communication
  channels the SHCI was able to base project
  activities on pre-existing assets and strengths
  in the community and avoid a duplication of
  efforts.

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Activities
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• Somali community health forums
• Six health education forums were held in the
  Somali community on the key disease areas. The
  format was usually a video and/or presentation by
  Somali and non-Somali health providers followed
  by a question and answer session. This provided
  community members with an opportunity to interact
  with respected health providers as well as
  fostered collaboration between Somali community
  organizations and health providers. Forums were
  broadcast on Somali TV, a local cable TV program.
• Conference series for health providers
• Six two-hour forums geared towards health
  providers serving the Somali community were held
  to answer questions about providing quality care
  to the Somali community. The forums covered the
  major disease areas and paired Somali and
  non-Somali health professionals to speak on the
  different issues. Resources, publications and
  health education materials were provided to
  participants.

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Somali women gather for breast cancer awareness
activities and demonstrations.
Dr. Osman and Dr. Pryce (HCMC Somali Medicine
Clinic) sharing information on cardiovascular
disease and diabetes at Somali Community Forum.
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• Somali health survey and focus group research
• Health data specific to the Somali community are
  scarce. The SHCI designed and implemented a
  community-wide health survey (with funding from
  MDH EDHI and Blue Cross Blue Shield Foundation of
  Minnesota) in order to gather specific health
  information to better understand the health
  knowledge and practices of the Somali community.
  Further in-depth qualitative data on selected
  disease areas will be gathered through focus
  groups in 2004 - 2005.
• Training of Community Health Workers
• Two part-time Somali community health workers
  (CHWs) were hired and trained in order to bridge
  the gap between the Somali and health provider
  communities. They are responsible for
  translating health materials, mobilizing the
  community to participate in program activities,
  and assisting with survey questionnaire
  development and data collection.
• Fitness classes for Somali elders
• A series of fitness classes are being implemented
  at a community center to teach elders simple
  movements to stay physically fit.

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Results
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Some of the successes of the SHCI

• Provider forum comments
• I think these forums are the first ones I have
  seen specifically designed for Somali health
  issues with a combination of American health
  professionals and Somalis who work in healthcare
  here or back in Somalia.
• The forums were very useful - it was kind of
  concrete in that they had some tools, books and a
  videotape that had been translated into Somali
  that were easy for me to use. Nice to hear the
  experience of other individuals.
• Community forum comments
• The forum was useful because I learned a lot of
  information regarding mothers and babies that I
  did not know about. In Somalia I know that, but
  here in America it is different.
• Even though I am already a mother, coming to the
  forum was useful because I got the opportunity to
  learn new things from different individuals.

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Breast and cervical cancer community forums

• Pre-post evaluation found that knowledge of
  breast and cervical cancer facts increased by 53
  among the women who participated.
• Other comments from Somali participants include
• I learned more about this disease. Before, I
  thought that only those who live in America and
  Europe can get it. Now I know that anybody can
  get it regardless of where they live or what kind
  of food they eat.
• It was so useful because even though I know
  about cancer, I still needed to know more about
  it and how can I protect myself from this deadly
  disease.
• In general the community forums have been able to
  reach a broad audience through attendance at the
  forums themselves, and also via broadcast on
  Somali TV, which reaches 9 in 10 Somali adults.

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Lessons Learned
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• Community mobilization and partnerships take
  time.
• The Somali community relies on oral communication
  channels so it is therefore important to identify
  these effective channels and utilize existing
  networks to disseminate health information. It
  is essential to hold weekly partner meetings in
  order to keep staff informed and foster a team
  approach to activities.
• Health competes with many other community
  priorities (immigration, housing, education,
  employment).
• It is important to recognize that immigrant and
  refugee populations have many competing
  priorities that they are dealing with in addition
  to health.
• Numerous barriers include transportation,
  language, time difficulties, children.
• Health education for the Somali community needs
  to shift to a more community-oriented paradigm.
  Providers have recognized that immigrant and
  refugee patients have difficult navigating the
  current health system and there are many barriers
  to them successfully accessing care. Therefore,
  the development of a more community-oriented
  system utilizing the expertise of CHWs will prove
  invaluable.

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• Few health education materials available geared
  towards the Somali community.
• There is a growing need for more health education
  materials to be produced for the Somali
  community. It is not enough to simply translate
  the words into the Somali language it is also
  essential to collaborate with community members
  to produce high-quality materials that are also
  culturally appropriate. The SHCI is filling this
  niche.
• Health education alone is not enough to affect
  behavior change.
• The educational materials and forums provide
  valuable information to the community on
  different health issues, however, it is important
  to provide an opportunity to build skills and
  increase opportunities for behavior change (e.g.
  - through fitness classes).
• Health data are lacking for the Somali community.
• There is a high demand for data that documents
  and quantifies both the health needs and assets
  of the Somali community. There is anecdotal
  evidence that there are critical health needs in
  the Somali community, but there is a great need
  for more quantitative data about knowledge
  levels, health practices and health system access
  in the Somali community. SHCI is providing some
  of this critical baseline information through its
  large scale Somali health survey.