RESEARCH POSTER PRESENTATION DESIGN © 2015

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Population Health Global Community Partnership

Understand social determinants of health and identify specific examples relevant to this community

Learn how to engage community partners in the assessment of sustainability for the medical mission collaborative for this population

Develop a step-wise evidence based approach to community assessment in the Dominican Republic

Literature Search Standardized tools and surveys used for the evaluation of short term medical

mission trips were reviewed with items modified to fit our specific population. Items included questions related to the experience involving roles, goals,

motivation, expectations, and impact from the pre-trip preparation, medical mission week, and post trip to find common trends.

Survey item questions were also brainstormed with faculty and student leaders to create questions aligned with the survey goal.

Methodology The survey and key informant interview needs assessment included previous

participants (students, preceptors, partners) from UMASS Dominican Republic Medical Missions.

Survey items were converted into a variety of question forms using the software Survey Monkey and were sent to preceptors and students N= 172 using saved participant lists from previous years.

As an incentive for taking the survey, a $25 gift certificate raffle entry was offered to those who completed the survey.

Analysis of data included use of the Survey Monkey software with open ended responses coded using content analysis.

Preliminary Findings: Past Participant Survey (n=33 respondents) “Changes to make the trip more impactful?”

Majority Response: Sustainability/Continuity of Care “Changes to increase involvement in future trips?”

Reduced Cost/Financial Barriers “Most valued aspect of the trip?”

Learning/Development of Clinical Skills

Additional Findings (n= 7 respondents, Theme & Subthemes)

Summary of Future Directions

References 1. Bilton, M. (2011). Community health needs assessment. Trustee. 64(9), 21-24. 2. Green, T., Green, H., Scandlyn, J., & Kestler, A. (2009). Perceptions of short-

term medical volunteer work: a qualitative study in Guatemala. Global Health, 5(4), 1-13.

3. Maki, J., Qualls, M., White, B., Kleefield, S., & Crone, R. (2008). Health impact assessment and short-term medical missions: a methods study to evaluate quality of care. BMC health services research, 8(1), 121.

4. Roberts, M. (2006). Duffle bag medicine. Jama, 295(13), 1491-1492. 5. Rowe, A., McClelland, A., & Billingham, K. (2001). Community Health Needs

Assessment: An Introductory Guide for the Family Health Nurse in Europe. Retrieved October 21, 2015.

6. Suchdev, P., Ahrens, K., Click, E., Macklin, L., Evangelista, D., & Graham, E. (2007). A model for sustainable short-term international medical trips. Ambulatory Pediatrics : The Official Journal of the Ambulatory Pediatric Association,7(4), 317-320. doi:S1530-1567(07)00059-7 [pii]

7. U.S. Centers for Disease Control and Prevention. Community Health Assessment for Population Health Improvement: Resource of Most Frequently Recommended Health Outcomes and Determinants, Atlanta, GA: Office of Surveillance, Epidemiology, and Laboratory Services, 2013.

Acknowledgements

We would like to thank all of the collaborators that helped us through this process, especially Elizabeth Townsley and Nicholas Hathaway. Additionally we are grateful to the interviewees for sharing their valuable time and thoughts.

Discussion of Various Dominican Batey Partners UMMS Students & Preceptors, Good Samaritan Mission partners, batey

community Epidemiology Communicable diseases: Cholera, Chikungunya, Hepatitis, HIV, TB, STIs, URIs Non-communicable disease : diabetes, hypertension, fever, maternal-child

health, infant mortality, skin infections, stomach pain Social Determinants Citizenship status, location, insurance, occupational environment,

racial/cultural bias, gender (male workers) Societal Manifestations & Implications Short-term medical mission trips: “Duffle Bag” Medicine vs. sustainable batey

health

Population Health Clerkship 2015, Dominican Republic Team

Kathryn DiFiore RN, Alicia Filewicz RN, Nicholas Keeler RN, Jason Lau, Jean Boucher, ANP-BC, PhD, Olga Valdman, MD

Dominican Republic Batey Health: Development of a Strategic Plan

Methods Surveys were conducted on three different bateyes to determine basic health

needs 1/3 of the houses on each batey were randomly chosen and surveyed Surveys were conducted with a medical and nursing student interviewer and

interpreter Data was collected and analyzed to understand the legal status of all individuals

on the bateyes Preliminary Findings 47 surveys, including 186 individuals were conducted Patient data analyzed included: gender, age, and legal status. Legal status was recorded as: no papers, Haitian passport or Haitian birth

certificate, Dominican birth certificate, Cedula, other and unknown. Over 50% of the individuals did not have legal papers Approximately 25% had only a Haitian passport or birth certificate (which does

not grant them legal status as a worker) Males and females had similar data results More children (44.6%) had Dominican birth certificates compared to adults

(20.4%) Many of the children (33.8%) had no papers

The UMass Medical School has partnered with the Good Samaritan Mission Organization in La Romana, Dominican Republic, for the last nine years, to

participate in a medical mission collaborative that includes an annual spring trip with nursing and medical students. The intent of this population health

clerkship focused on addressing previously collected data and the formulation of an approach for meeting the local needs of the community through more

sustainable systems and interventions.

1. A complete and thorough literature review was conducted

WHO Organization CDC Public Health Institute BioMed Central

2. In-depth discussion utilizing evidence based research dictated methodology What are basic needs of all human beings? (Maslow’s Hierarchy) What are the community's suspected needs/issues? What do we want to learn? Why do we want to learn it? Does every question have a purpose?

3. Survey Questions were developed to assess basic needs and to identify problems in the bateyes that may require future intervention

Peace Care: Dominican Republic-a partnership between Peace Corps, DR,

the community of Guaymate and two US universities to build local health capacity

Hospital el Buen Samaritano: established to help batey workers; hires and trains health promoters in the bateys

Hospital Municipal de Guaymate: Serves approximately 33,000 patients a year with a budget of US $7,000/month; 95% of those served are Haitian batey workers with documentation issues

180 Grados: A Spanish NGO that works with small community enterprises, the JMDS youth group and Hospital Guaymate

Central Romana, Hospital Salud Publico, Hospital Seguro Social

Household Survey Data

0

10

20

30

40

No Papers Dominican Birth Other

Perc

enta

ge

Male vs Female

Male Female

01020304050

No Papers Dominican Birth Other

Pere

ntag

e

Children vs Adult

Children (≤15 yr) Adult (>15 yr)

Past Participant Surveys and Key Informant Interviews Continue to collect past participant surveys and utilize survey results to guide key

informant interviews Broaden our key informant interview population to include our partners at Buen

Samaritano and other partners in the Dominican Republic Evaluate key informant interviews to identify areas of strength and weakness Develop a five year plan using the identified areas of strengths and weakness Community Assessment Implementation of Survey Question during future DR mission trips (March 2016) Analyze basic health needs through collected data Understand next steps going forward to address the needs of the bateyes Address limitations in data collection including cultural and resource barriers Reflect on quality of questions and significance of data Modification and improvement of Survey Tools Needs Recognition and in-depth focus on identified problems for future trips Additional mission trips with modified and improved tool kits Data Management Previous survey assessments have emphasized the need for increased usability for data collection and better standardization and rigor for data retrieval and analysis. Future solutions include: implementing more selectable answers for interview questions (i.e. drop down

bars or radio buttons) lightweight software than can be used on mobile devices and increase

accessibility data storage in a format that is readily accessible for analysis

Guiding Principles of Short Term International Health Trips

1. Creation of a mission statement 2. Partnership and collaboration with NGOs, government agency, or other local

organization 3. Education for ourselves, the community, and our peers 4. Service through data collection, targeted interventions, and implementation of

sustainable clinical care 5. Teamwork through the involvement of a diverse variety of specialists 6. Sustainability through a demonstrated commitment to an ongoing relationship

while working within existing systems of care 7. Evaluation through the analysis of clinical and laboratory data collected annually

from trips to determine the effectiveness of our interventions and the changes needed

Conduct a survey and key informant interview with current partners and past participants about roles, missions and sustainability with the target population

Analyze data collected from household surveys conducted in the adopted batey communities

Creation of a toolkit for future community engagement assessments

Project Goals

Relevant Factors for Population of Focus

Learning Objectives

Key Advocacy Organizations for Interprofessional Collaboration

Step-Wise Approach to Community Assessment

Past Participant and Key Informant Needs Assessment

Roles

Things Learned

UMMS Dominican Republic La Romana Batey Experience

Sustainability

Goals Motivations Expectations