Ventanilla de Salud (VDS) Mobile Program Providing access to health to Latinos

in Southwest Kansas Johana Bravo; Yazmin Reyna; Alejandro Gutierrez; Victor Martinez;

Won Choi, PhD, MPH; Edward Ellerbeck, MD, MPH; Paula Cupertino, PhD

Percent of Latino population in the state of Kansas by County

Source: U.S. Census Bureau, 2010 Census

Counties with ≤ 7%

KUMC

BACKGROUND Drawn by opportunities in service, agriculture, and meatpacking industries, Latinos have become the fastest

growing minority group in Kansas: - Latinos represent 11% of Kansas population. - 84% of them are of Mexican origin. - 28% of Latinos in Kansas lack health insurance coverage. - Latinos in Kansas are more likely to be recent immigrants, younger age, and low education status.

Latinos are more predisposed to chronic conditions: - “At present, Hispanic have a lower prevalence of many conditions than the population as a whole, but

they have a higher prevalence of diabetes than non-Hispanic whites (10.5%, 6.7% respectively). Furthermore, their rates of overweight and obese adults are relatively higher than those of non-Hispanic whites.”

- Premature death from heart diseases was higher for Hispanics (23.5%) than non-Hispanics whites (16.5%).

Latinos face additional barriers to health access and quality: - Language barriers - Low average income and education - How acculturated - Immigration status - Occupational characteristics - Uninsured rate

OBJECTIVE 1. To develop a Community-based participatory research (CBPR) infrastructure for health

services access in rural Kansas.

2. The development of an alternative venue to implement a culturally relevant intervention that will promote access to preventive health screening and health education among Latinos.

3. To implement a community-based risk assessment to identify the health profile of Latinos and provide case management for those at high risk in rural Southwest Kansas.

METHODS

To develop a CBPR infrastructure for health services access in rural Kansas

1. Formed a Community Advisory Board (CAB) with key stakeholders including community leaders, commissioners, community health clinics administrators, media agencies, and researchers.

2. Monthly meetings to follow-up on project development, implementation, and evaluation.

The development of an alternative venue to implement a culturally relevant intervention that will promote access to preventive health screenings, health education, and healthcare among Latinos.

1. Organize large community-based health events in targeted cities with high Latino population.

2. Train community health workers (CHW) in rural Kansas to serve as community mobilizers.

3. Educate CHW on community health needs and preventive screenings.

To implement a community-based risk assessment to identify the health profile of Latinos and provide case management for those at high risk in rural Southwest Kansas.

1. Develop standardized protocols to guide implementation, data collection, case management, and evaluation of chronic diseases risk assessment (diabetes, hypertension, and obesity).

2. Partner with local community health clinic to connect participant with primary care physicians.

FLOW OF EVENT & FOLLOW-UP

MÍDETE Participants obtain their BMI, blood glucose, and blood pressure measurements.

ENTÉRATE Participants receive a print out and/or verbal explanation of their screening results.

ANÍMATE Participants receive health education information to develop an action plan.

* All the measurements are guided by the CDC protocols and regulations

FOLLOW-UP: Participants with no risk receive a mailed congratulation letter. Participants at high risk receive a mailed letter explaining their results, and a risk reduction plan. Participants identified as potential cases are referred to a local community safety net clinic or to their

healthcare provider to address health concern.

MEASURES AND ANALYSIS

A standardized registration form was developed to describe demographics, socio-economic characteristics and health needs of all participants. Registration forms obtain data on:

- Sociodemographics

- Personal health status

- Attendance to previous health fairs

- Health insurance status

- Smoking status

- Family medical history

- Basic health screenings

Study data was collected and managed using RedCap.

SPSS was used to calculate frequencies, descriptive statistics on demographics, and chi-square analysis was used to complete group comparisons between age, and gender between normal and at high risk.

Participants Demographics (N = 1,746)

Demographics Number of Participants

N (%)

Age (years)

Under 18

18 – 29

30 – 39

40 - 49

Over 50

181 (10.4)

445 (25.5)

457 (26.2)

424 (24.3)

228 (13.1)

Gender

Female 500 + 216

989 (56.6)

State

Kansas

Other

1,490 (85.3)

253 (14.5)

Ethnicity

Hispanic/Latino

1,666 (95.4)

Country of Origin*

México

USA

Other

1,178 (95.9)

33 (2.7)

19 (1.5)

Time living in US*

≤ 5 year

6 to 10 years

< 10 years

98 (8.4)

272 (23.4)

772 (66.6)

Education Level*

Less than high school graduate

High school graduate, GED or Higher education

649 (60.7)

416(39.1)

Health Insurance

Yes

464 (26.6)

*Registration form was modified in August 2012 and fields for country of origin, time in the US, and education level were added.

Percent of adult Latino participants screened per city

City Number of participants Total Latino Adult Population

% of participants per city screened (adult Latino population)

Salina 46 3,020 1.52

Dodge City 213 9,310 2.29

Garden City 686 8,063 8.51

Liberal 631 7,149 8.83

Great Bend 170 1,690 10.1

Risk Assessment Protocol Post event

Participants are categorized into one of the following groups: 1. Healthy:

- BMI < 29 Kg/m2

- BP <120/80 mm Hg

- FBG < 100mg/dL | NFBG < 140mg/dL

2. High Risk:

- BMI > 30 Kg/m2

- BP 120-139 mm Hg systolic | 80-89 mm Hg diastolic

- FBG 100-125mg/dL | NFBG 140-199mg/dL

3. Potential case:

- Previous diabetes and/or hypertension diagnosis

- BP > 140/90 (on two takes)

- FBG >126mg/dL | NFBG > 200mg/dL

Exclusion criteria: - Under 18 years old

- Missing at least one data measurement

Exclusion criteria:

-Under 18 years of age

-No screening data or missing values

n=230 (13.2%)

Screenings

n=1,746

Potential case

n=221 (12.7%)

Previous Diabetes or Hypertension

diagnosis

Fasting blood glucose (FBG): >126 mg/dL

Non fasting blood glucose (NFBG): >200 mg/dL

Blood pressure >140/90

(on two takes)

High Risk

n=934 (53.5%)

FBG: 100-125 mg/dL

NFBG: 140-199 mg/dL

Blood pressure:

120-139 mm/Hg Systolic

80-89 mm/Hg Diastolyc

Body Mass Index (BMI): >30 Kg/m2

Healthy:

n=361 (20.7%)

-BP <120/80 mm HG

-FBG <100 mg/dL

-NFBG <140 mg/dL

-BMI <29 Kg/m2

Flowchart for Identification of Participants

Participants BMI, Blood Pressure, and Blood glucose overall results

Number of

Participants

N (%)

Body Mass Index (N=1,400)

Normal (18.5-24.9)

Overweight (25-29.9)

Obese (≥30)

283 (20.2)

571 (40.8)

546 (39)

Blood Pressure (N=1,532)

Normal (<120/80)

Pre-hypertension (between 120/80 mm HG & 139/89)

Hypertension (> 140/90)

515 (33.6)

678 (44.3)

339 (22.1)

Blood Glucose (N=1,229)

Normal (FBG: <100mg/dL | NFBG: <140mg/dL)

Pre-diabetic (FBG: 100-125mg/dL | NFBG: 140-199mg/dL)

Diabetic (FBG: >126mg/dL | NFBG: >200mg/dL)

961 (78.2)

172 (14.0)

96 (7.8)

Prevalence of Obesity, Hypertension, and Diabetes in Hispanic Americans and Mexico

• Hispanic Americans (2011)

– 16.8 million adults with obesity (31.8%)

– 11.9 million adults with hypertension (22.5%)

– 6.9 million adults with diabetes (13.2%)

• Mexico (2012)

– 36.2 million adults with obesity (32.4%)

– 22.4 million adults with hypertension (20%)

– 6.4 million adults with diabetes (6%)

Median age US: 37 years old Median age Mexico: 27 years old

Median age Hispanic Americans: 25 years old

Body Mass Index Stratified by Gender & Age group

AGE (N = 1,391)

18-29

N=392 (28.2%)

N (%)

30-49

N=793 (57.0%)

N (%)

50 and over

N=206 (14.8%)

N (%)

P-value

Body Mass Index

Normal (18.5 – 24.9)

Overweight (25 - 29.9)

Obese (≥30)

152 (38.8)

136 (34.7)

104 (26.5)

113 (14.2)

338 (42.6)

342 (43.1)

19 (9.2)

92 (44.7)

95 (46.1)

0.001*

GENDER (N = 1,398)

Female

N=795 (56.9%)

N (%)

Male

N=603 (43.1%)

N (%)

P-value

Body Mass Index

Normal (18.5 – 24.9)

Overweight (25 - 29.9)

Obese (≥30)

165 (20.8)

303 (38.1)

327 (41.1)

119 (19.7)

267 (44.3)

217 (40.0)

0.058

Blood Pressure stratified by Gender & Age group

AGE (N = 1,460)

18-29

N=404 (27.7%)

N (%)

30-49

N=838 (57/4%)

N (%)

50 and over

N=218 (14.9%)

N (%)

P-value

Blood Pressure

Normal (<120/80)

Pre-hypertension (120/80 – 139/89)

Hypertension (>140/90)

212 (52.5)

155 (38.4)

37 (9.2)

242 (28.9)

400 (47.7)

196 (23.4)

29 (13.3)

92 (42.2)

97 (44.5)

0.001*

GENDER (N = 1,467)

Female

N=839 (57.2%)

N (%)

Male

N=628 (42.8%

N (%)

P-value

Blood Pressure

Normal (<120/80)

Pre-hypertension (120/80 – 139/89)

Hypertension (>140/90)

348 (41.5)

337 (40.2)

154 (18.4)

133 (21.2)

312 (49.7)

183 (29.1)

0.001*

Blood Glucose stratified by Gender & Age group

AGE (N = 1,187)

18-29

N=332 (28.0%)

N (%)

30-49

N=698 (58.8%)

N (%)

50 and over

N=157 (13.2%)

N (%)

P-value

Blood Glucose

Normal (<100)

Pre-Diabetic (100-125)

Diabetic (≥126)

302 (91.0)

26 (7.8)

4 (1.2)

539 (77.2)

103 (14.8)

56 (8.0)

96 (61.1)

25 (15.9)

36 (22.9)

0.001*

GENDER (N = 1,227)

Female

N=707 (57.6%)

N (%)

Male

N=520 (42.4%)

N (%)

P-value

Blood Glucose

Normal (<100)

Pre-Diabetic (100-125)

Diabetic (≥126)

550 (77.8)

95 (13.4)

62 (8.8)

410 (78.8)

76 (14.6)

34 (6.5)

0.325

RESULTS 13 events have been organized between March 2012 and July 2013 in rural Southwest Kansas.

1,746 participants have attended the VDS mobile events.

- Under 18: 181 (10.4%)

- 18 and older: 1,554 (89.6%)

50 volunteers received culturally appropriate training on basic health screenings, and educational materials to disseminate at mobile events following standardized protocols. Volunteers include: CHWs, medical providers, Juntos staff, and medical students.

Each health fair provided basic health screenings: BMI, finger stick blood glucose, and blood pressure; and provided culturally sensitive educational information on: skin cancer, breast cancer, nutrition and exercise, smoking cessation programs, dental hygiene, and STDs.

221 participants were identified as potential cases and were referred to local community health clinic

934 participants were identified at high risk. Participants were explained their results and advised to start a risk reduction plan.

80 participants were enrolled in the Mexican public health insurance Seguro popular.

CONCLUSION The CBPR infrastructure developed has served as a foundation for the health services access

initiatives to combine all stakeholders skills to improve the health of Latinos in rural Southwest Kansas.

The program has led to the early detection of specific cases of participants at high risk of developing diabetes, obesity, and hypertension. In addition, we have been able to refer participants to a local community clinic to receive primary care for potential cases.

Our population have similar prevalence rates in comparison to the United States and Mexico in obesity, hypertension, and diabetes however the median age of recent Mexican immigrants is lower. Therefore, they are having higher incidence of chronic diseases at a younger age.

Results state that men have a higher prevalence of hypertension compare to women, as shown in the literature. Our program has served as a positive venue to obtain male participants (43.4%).

Considering that these chronic diseases are related to lifestyle practices; by providing culturally sensitive information, promotores de salud are educating and promoting healthier habits thus, preventing the incidence of chronic diseases.

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