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Using Community-Based Participatory Research to Develop Geospatial Models Toward Improving Community Health for Disadvantaged Hispanic Populations in Charlotte, NC

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Abstract

Hispanic immigrant communities across the U.S. experience persistent health disparities and barriers to primary care. We examined whether community-based participatory research (CBPR) and geospatial modeling could systematically and reproducibly pinpoint neighborhoods in Charlotte, North Carolina with large proportions of Hispanic immigrants who were at-risk for poor health outcomes and health disparities. Using a CBPR framework, we identified 21 social determinants of health measures and developed a geospatial model from a subset of those measures to identify neighborhoods with large proportions of Hispanic immigrant populations at risk for poor health outcomes. The geospatial model included four measures—poverty, English ability, acculturation and violent crime—which comprised our Hispanic Health Risk Index (HHRI). We developed a Primary Care Barrier Index (PCBI) to determine (1) how well the HHRI correlated with a statistically derived composite measure incorporating all 21 measures identified through the CBPR process as being associated with access to primary care; (2) whether the HHRI predicted primary care access as well as the statistically-derived composite measure in a statistical model; and (3) whether the HHRI identified similar neighborhoods as the statistically derived composite measure. We collapsed 17 of the 21 social determinants using principal components analysis to develop the PCBI. We determined the correlation of each index with inappropriate emergency department (ED) visits, a proxy for primary care access, using logistic generalized estimating equations. Results from logistic regression models showed positive associations of both the HHRI and the PCBI with the use of the ED for primary care treatable conditions. Enhanced by the knowledge of the local community, the CBPR process with geospatial modeling can guide the multi-tiered validation of social determinants of health and identify neighborhoods that are at-risk for poor health outcomes and health disparities.

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Acknowledgements

We would like to acknowledge the contributions of the community advisory board, which helped develop the concept for this research and provided valuable input throughout the project, as well as other members of the research team including: Dr. Janni Sorensen; Dr. Maren Coffman; Patricia Avraham; and Miriam Espaillat.

Funding

Funding for this research came from the National Institutes of Health’s National Center on Minority Health and Health Disparities (NCMHD), specifically the NCMHD Advances in Health Disparities on Social Determinants of Health (R01). The only role the funder has played in this research has been receiving and reviewing annual progress reports on the study.

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Authors and Affiliations

  1. Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA

    Thomas M. Ludden, Brisa Urquieta de Hernandez, Hazel Tapp & Michael F. Dulin

  2. Center for Outcomes Research and Evaluation (CORE), Atrium Health, Charlotte, NC, 28203, USA

    Yhenneko J. Taylor

  3. Urban Institute, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA

    Laura K. Simmons

  4. Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA

    Heather A. Smith & Owen J. Furuseth

Authors
  1. Thomas M. Ludden
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  2. Yhenneko J. Taylor
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  4. Heather A. Smith
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  5. Brisa Urquieta de Hernandez
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  7. Owen J. Furuseth
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  8. Michael F. Dulin
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Correspondence to Thomas M. Ludden.

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The authors declare they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval (#09-10-19B) was received by the IRB September 15, 2010 and was renewed annually for the life of the study.

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Informed consent was obtained from all individual participants included in the study.

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Ludden, T.M., Taylor, Y.J., Simmons, L.K. et al. Using Community-Based Participatory Research to Develop Geospatial Models Toward Improving Community Health for Disadvantaged Hispanic Populations in Charlotte, NC. J Primary Prevent 39, 171–190 (2018). https://doi.org/10.1007/s10935-018-0505-z

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