The Future of Nursing in Eliminating Health Disparities Nilda (Nena) Peragallo, DrPH, RN, FAAN Dean & Professor University of Miami School of Nursing and Health Studies
Program of Research: A Community and Culturally-Based Intervention Model for Latinos Nilda P. Peragallo, DrPH, RN, FAAN Focus groups HIV/AIDS Risk reduction for Latinas (1997-1998) Funded by UIC/Great Cities Faculty Research fund N=49 Random Survey on Attitudes of RNs towards AIDS Patients Funded by: UCF, Research Fund. (1988) N=542. In Depth Semi-structured Interviews to AIDS patients A nursing intervention to prevent AIDS in Chile Funded by NIH/USAID Family Health International (1990-1992) N=44 Survey HIV Testing Sites (1990-1992) Funded by NIH/USAID Family Health International Instrument Re-Testing HIV Risks among Latinas (1995) Funded by UIC, college of nursing, Research Fund N=30 Structured Interviews HIV/AIDS Risk reduction for Latinas (1997-1998) Funded by UIC/Great Cities Faculty Research fund N=30 Instrument Development/Pilot Testing HIV Risk Assessment for Latinas (1989) Funded by: Robert Wood Johnson Clinical Nurse Scholars Program N=10. Descriptive study Effects of culture on Risk for HIV among Latinas (1989) Funded by: Robert Wood Johnson Clinical Nurse Scholars Program N=120. Instrument development/pilot Testing A nursing intervention to prevent AIDS in Chile (1990-1992) Funded by NIH/USAID Family Health International N=6. Comparison study Reported risk factors to Ministry of Health and reported in in-depth interview with nurses (1990-1992) Funded by NIH/USAID Family Health International Descriptive study Breast cancer screening practices in Mexican and Puerto Rican Women Funded by Illinois Department of Public Health. (1995) N=111 Descriptive study Cervical cancer screening practices in Mexican and Puerto Rican Women (1995) Funded by Illinois Department of Public Health N=111 N=44 Instrument development/pilot Testing HIV Risks among Latinas In Depth Interviews Communication with sexual partners among Latinas (1995) Funded by UIC, college of nursing, Research Fund N=6 Survey Breast cancer and cervical screening practices among minority women (1996) Funded by Illinois Department of Public Health N=529 (1995) Funded by UIC, College of Nursing, Research Fund N=18 Group intervention Community Outreach Model: Women's Health Program with Latinas (1999-2000) Funded by Procter & Gamble N=180 Pilot Testing HIV/AIDS Risk reduction Intervention:SEPA (1997-1998) Funded by UIC/Great Cities Faculty Research fund N=10 Randomized Trial HIV/AIDS Risk reduction Program: SEPA (1999-2003) Funded by NIH/NINR # R01 NR0476 N=768 Drugs & Violence in the Americas: DYVA Multicentric Pilot Study Funded by CICAD/OAS (2006-07) N=90
EL CENTRO Center of Excellence for Hispanic Health Disparities Research http://www.elcentro.sonhs.miami.edu/ Funded by NCMHD Grant 1P60 MD002266 to Nilda Peragallo, PI
The Primary Mission of El Centro To advance the scientific development and evaluation of culturally-tailored interventions in a constellation of behaviorally-rooted health conditions that disproportionately affect Hispanics: Substance abuse HIV/AIDS and sexually transmitted infections Family and intimate partner violence Co-occurring mental health conditions that impact and are impacted by these other conditions
Why Culturally-Tailored Interventions? Cultural groups have unique values, beliefs, behaviors and histories that directly impact health and the efficacy of interventions. Few intervention studies have sufficiently large subsamples of a particular cultural group to evaluate the efficacy of the intervention for that group. Interventions that have not been designed for or adequately tested on a particular cultural group are probably not ready for widespread utilization for that group.
Culturally-Tailoring an Intervention Make the intervention comfortable & familiar Address the unique challenges and sensitivities of the group Use cultural strengths as building blocks for change Learn from your clients
Engaging Latinas in Health SEPA II Example: Interventions Once participant attend one session, they engaged in the entire intervention 95% retention What is attractive to participants? Latina, Nurse led intervention Empowerment/Pedagogy of the Oppressed (Friere, P) Peer support Trust Personalismo
Common Findings from Program of Research Accessing marginalized populations Barriers to accessing healthcare High rates of depression and violence The important role of culture & context Acculturation (not one dimensional) Hispanic stress Machismo and male infidelity Alcohol and drug use Social discrimination amongst peers
Critical Role of Nursing in Eliminating Health Disparities Nurses are ideally suited because of: Holistic approach Most trusted healthcare professionals History of working with marginalized groups Ability to partner with communities and serve as advocates Longstanding practice and research contribution in working with most vulnerable communities
The Future Nursing Role in Eliminating Health Disparities Primary providers of health services for disparities populations Development of comprehensive culturally tailored interventions Going back to our roots in community-oriented health care delivery models Care delivery in and with the community (e.g., newborn visits, schools, nurse run clinics in marginalized communities and neighborhoods)
Thank you very much Gracias