Evidence-Based Practice for Public Health Emergency Preparedness and Response (2020) / Chapter Skim
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Appendix B1: Mixed-Method Review of Strategies for Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations
Appendix B1: Mixed-Method Review of Strategies for Engaging with and Training Community-Based Partners to Improve the Outcomes of At-Risk Populations
Pages 293-332
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. The theory behind this public health emergency preparedness and response (PHEPR)
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• hat are the barriers to and facilitators of effective engagement and training of CBPs? W Engaging with and training CBPs may improve the outcomes of at-risk populations following a public health emergency through a number of presumed pathways (see the analytic framework in Figure B1-1)
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» Increased capacity to reach Organizational level Organizational/system level » Increased capacity at-risk populations and (Community-Based Partners) » Increased participation in to reach and deliver services after public » Increased knowledge regarding and diversity of health care health emergency emergency preparedness and coalitions and other partner- educate at-risk response concepts and needs of ships; increased organizational populations » Improved reach/timeliness at-risk populations during/after networks before a public of risk communications public health emergencies health emergency targeting at-risk populations » Increased continuity of » Increased belief in ability to meet operations/disaster planning » Improved reach/ needs of at-risk populations timeliness of risk » Improved coordination with communications Individual level (at-risk population)
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1. Determining Evidence of Effect Seven quantitative comparative and four quantitative noncomparative studies directly addressed the overarching key question regarding the effectiveness of different strategies for engaging with and training CBPs to improve the outcomes of at-risk populations after public health emergencies. All 11 studies examined strategies for engaging with or training CBPs before a public health emergency (preparedness phase)
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APPENDIX B1 297 FIGURE B1-2 Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram for the mixed-method review of strategies for engaging with and training community-based partners to i mprove the outcomes of at-risk populations.
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• implementation of culturally tailored preparedness2 training programs for CBPs and at-risk populations they serve, • engagement of CBPs in preparedness outreach activities targeting at-risk populations, and • engagement and training of CBPs in coalitions addressing public health preparedness/ resilience. A meta-analysis of the evidence for the effectiveness of these strategies was not feasible, so the committee conducted a synthesis without meta-analysis (as described in Chapter 3)
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The parallel evidence was considered recognizing that the engagement and training of CBPs to better reach and improve outcomes for individuals with social vulnerabilities has much broader application in public health beyond the PHEPR context, and the committee believes this broader body of evidence may have some applicability to the PHEPR practices evaluated in this review. Implementation of Culturally Tailored Preparedness Training Programs for CBPs and At-Risk Populations They Serve Evidence from quantitative research studies Five quantitative comparative studies examined the effects of culturally tailored preparedness training programs for CBPs and at-risk populations they serve.
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. After receiving training in emergency preparedness, six experienced Vías de la Salud health promoters conducted group educational sessions with Latino residents in Montgomery County, Maryland.
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addressed questions related to the effectiveness of culturally tailored preparedness training programs for CBPs and at-risk populations they serve. In a pilot of the earlier-described PFA training program implemented by McCabe and colleagues (2014a,b)
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. Other evidence that may inform effectiveness As noted earlier, in addition to the above direct evidence on tailored strategies for engaging with and training CBPs, the committee considered parallel evidence consisting of systematic reviews of community engagement and culturally tailored interventions used outside the PHEPR context to improve the outcomes of at-risk or disadvantaged populations (primarily populations of low socioeconomic status and racial/ethnic minorities)
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As a result, the committee considered parallel evidence to be supportive3 rather than very supportive. Summary of the evidence: PHEPR knowledge of CBP representatives The committee concluded that there is low COE that culturally tailored preparedness training programs for CBPs and at-risk populations they serve improve PHEPR knowledge of CBP representatives.
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Summary of the evidence: Attitudes and beliefs of CBP representatives The committee concluded that there is very low COE that culturally tailored preparedness training programs for CBPs and at-risk populations they serve improve attitudes and beliefs of CBP representatives regarding their preparedness to meet needs of at-risk individuals. One cross-sectional (postintervention)
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study (McCabe et al., 2013) provide very low COE regarding the effects of culturally tailored preparedness training programs on CBP disaster planning (see Table B1-4)
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Summary of the evidence: PHEPR knowledge of trained at-risk populations The committee concluded that there is moderate COE that culturally tailored preparedness training programs for CBPs and at-risk populations they serve improve the PHEPR knowledge of trained at-risk populations. Two quantitative comparative studies (Eisenman et al., 2014; McCabe et al., 2014a,b)
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Summary of the evidence: Preparedness attitudes and beliefs of trained at-risk populations The committee concluded that there is low COE that culturally tailored preparedness training programs for CBPs and at-risk populations they serve improve attitudes and beliefs of trained at-risk populations regarding their preparedness. Two quantitative comparative studies (McCabe et al., 2014a,b; Montgomery County Department of Health and Human Services, 2008)
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Summary of the evidence: Preparedness behaviors of trained at-risk populations The committee concluded that there is moderate COE that culturally tailored preparedness training programs for CBPs and at-risk populations they serve improve preparedness behaviors of trained at-risk populations. Four quantitative comparative studies (Eisenman et al., 2009, 2014; McCabe et al., 2014a,b; Montgomery County Department of Health and Human Services, 2008)
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Engagement of CBPs in Preparedness Outreach Activities Targeting At-Risk Populations Evidence from quantitative research studies One quantitative comparative study examined the effect of engaging CBPs in preparedness outreach activities targeting at-risk populations. The study conducted by Coady and colleagues (2008)
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Summary of the evidence: Engagement of CBPs in preparedness outreach activities targeting at-risk populations The committee concluded that there is very low COE that CBP engagement in preparedness outreach activities improves the attitudes and beliefs of at-risk populations toward preparedness behaviors. One quantitative comparative study (Coady et al., 2008)
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= mixed effect/conflicting findings. Engagement and Training of CBPs in Coalitions Addressing Public Health Preparedness/Resilience Evidence from quantitative research studies One quantitative comparative study examined the effect of engaging multiple CBPs in coalitions and training them in PHEPR concepts on system-level outcomes related to improving outcomes for at-risk populations.
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Summary of the evidence: Engagement and training of CBPs in coalitions The committee concluded that there is very low COE that CBP engagement and training in coalitions addressing public health preparedness/resilience increases the diversity of coalitions, the coordination of CBPs with other response partners, or the capacity to reach and educate atrisk populations before an emergency. One quantitative comparative study (results described in Bromley et al., 2017, and Williams et al., 2018)
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Qualitative Evidence Synthesis Twenty qualitative studies (Andrulis et al., 2011; Bromley et al., 2017; Cha et al., 2016; Charania and Tsuji, 2012; Cordasco et al., 2007; Cuervo et al., 2017; Gagnon et al., 2016; Gin et al., 2016, 2018; Hipper et al., 2015; Ingham and Redshaw, 2017; Kamau et al., 2017; Laborde et al., 2011; Messias et al., 2012; Miller et al., 2015; Peterson et al., 2019; Rowel et al., 2012; Schoch-Spana et al., 2013; Shih et al., 2018; Stajura et al., 2012) supported a finding that engagement of community-based partners corresponded almost entirely to collaborations (coalitions and partnerships)
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At the same time, the body of qualitative studies notes several potential harms and/or undesirable impacts of CBP engagement. Participatory approaches to CBP engagement may be risky in that implicit biases may surface as explicit biases.
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. Another case report describes how a statewide tribal public health emergency preparedness network was perceived to have been strengthened as the result of a training collaboration among statewide tribal partners; the Arizona Department of Health Services; and the College of Public Health at the University of Arizona (Peate and Mullins, 2008)
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. 3. Acceptability and Preferences Qualitative Evidence Synthesis The body of qualitative studies indicated that CBPs were generally supportive of community preparedness goals and strategies for engagement and training, valuing both representation (inclusion)
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Additionally, emergency preparedness staff may need to develop new skill sets that go beyond traditional individual- and family-focused preparedness efforts to better encompass community coordination, neighborhood planning, and integration with nonemergency community-based activities. Reframing public health emergency preparedness practices to include a commitment to leveraging existing community health activities, along with a strong emphasis on health equity in all activities, can facilitate this organizational shift toward collaborative strategies and community preparedness (Plough et al., 2013)
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in 23 states and found that roughly 97 percent of respondents were willing to collaborate with their neighboring LHD or CHC in emergency preparedness or response activities. Three descriptive surveys support the findings from the qualitative evidence synthesis that leadership support is an important facilitator for the acceptability of PHEPR-related engagement and training.
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report that among Hispanic-serving CBOs that had recently participated in an emergency response, 50 percent said their resources and capabilities had been exceeded when responding, and 96 percent of those surveyed indicated they received little or no funding for public health emergency preparedness. Regarding commonly experienced barriers to integration into community preparedness activities, a national sample of CHCs cited a number of resource and capacity limitations, including staff limitations and time constraints (70 percent)
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. 6. Equity Qualitative Evidence Synthesis When CBPs and the at-risk populations they serve see themselves represented in community preparedness initiatives, they are more likely to engage in such efforts (Charania and Tsuji, 2012; Peterson et al., 2019)
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4 Ethical considerations included in this section were generated through committee discussions, drawing on the ethical principles laid out in Box 3-4 in Chapter 3 and key ethics and policy texts, including the 2009 Institute of Medicine letter report on crisis standards of care (IOM, 2009) , the 2008 Centers for Disease Control and Prevention white paper "Ethical Guidance for Public Health Emergency Preparedness and Response: Highlighting Ethics and Values in a Vital Public Health Service" (Jennings and Arras, 2008)
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These evidence benefits can be observed at multiple levels: synthesis • Case report • Individual level -- increased reach to at-risk populations, many of which are evidence traditionally underserved, which may improve at-risk individuals' PHEPR knowledge synthesis (no and preparedness behaviors, as well as access to critical services following a public assessment health emergency. of certainty or • Organizational level -- enhanced CBP PHEPR knowledge and preparedness to meet confidence)
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Similarly, if engaging communities in preparedness activities is an efficient means of achieving better preparedness, it is supported by the principle of stewardship, which is often considered to be of special importance in public health emergencies when resources can be very limited. Still, it is important to bear in mind that community engagement, like all human relationships, also can hold intrinsic value.
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. This finding is supported by 15 qualitative studies (Andrulis et al., 2011; Bromley et al., 2017; Cha et al., 2016; Charania and Tsuji, 2012; Cordasco et al., 2007; Cuervo et al., 2017; Gagnon et al., 2016; Gin et al., 2016, 2018; Ingham and Redshaw, 2017; Laborde et al., 2011; Miller et al., 2015; Peterson et al., 2019; Rowel et al., 2012; Stajura et al., 2012)
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report an example in which two coalition members could perform the leadership roles effectively, an approach that may alleviate the burden for any one member. Case Report Evidence Synthesis The case report evidence shows that effective engagement of CBPs is tied to efforts to maintain culturally competent trainings and services aligned with the needs of the target audience, which, although time consuming, is important (McCabe et al., 2011; Peate and Mullins, 2008; Wells et al., 2013)
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. 9. Facilitators for CBP Training Qualitative Evidence Synthesis Eleven qualitative studies (Ablah et al., 2008; Bromley et al., 2017; Cha et al., 2016; Gin et al., 2016, 2018; Hipper et al., 2015; Kamau et al., 2017; Laborde et al., 2011; Rowel et al., 2012; Schoch-Spana et al., 2013; Stajura et al., 2012)
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2012. Emergency preparedness training of tribal community health representatives.
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2008. Community health centers and emergency preparedness: An assessment of competencies and training needs.
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2010. Emergency preparedness training and response among community health centers and local health departments: Results from a multi state survey.
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2008. Disaster preparedness training for tribal leaders.
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2008. Ethical guidance for public health emergency preparedness and response: Highlight ing ethics and values in a vital public health service.
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