Applying Community-Based Participatory Approaches to Addressing Health Disparities and Promoting Health Equity

This special issue highlights work that contributes to our understanding of health disparities and community-based participatory research (CBPR) approaches to promoting health equity across diverse populations and issues that matter to communities. We take on a global perspective, and thus, various efforts across international contexts are illustrated. Articles elucidate a variety of CBPR approaches designed to empower and build capacity among individuals and communities in order to seek changes at the level of community practices, programs, and systems. These articles span across diverse populations—children, youth, and families; adults and older adults; immigrants; refugees; Black people; Latinx people; Native Americans/Indigenous people, the Roma community; Muslim women, and women with disabilities—experiencing inequities of interest to community psychologists and other researchers and practitioners.     

The effects of news report valence and linguistic labels on prejudice against social minorities

ABSTRACT

Combating prejudice against social minorities is a challenging task in current multicultural societies. Mass media can decisively shape prejudice, because it often represents the main source of information about social minorities. In 3 studies in the Czech Republic (N = 445) and Switzerland (N = 362; N = 220), we investigated how prejudice against negatively and positively perceived minorities (the Roma in Study 1, Kosovo Albanians in Study 2, Italians in Study 3) is influenced by a single exposure to a print news report, by manipulating the valence of reports about minority members (positive vs. negative vs. mixed) and linguistic forms for minorities’ ethnicity (nouns vs. adjectives). Positive and negative reports shaped prejudice in the respective directions; the effect of mixed reports mostly did not differ from positive reports. Labeling ethnicity with nouns (e.g., a male Roma) resulted in more prejudice than adjectives (e.g., a Roma man), independent of report valence. Report valence influenced the affective part of prejudice (i.e., feelings toward a minority), whereas language consistently shaped the behavioral part of prejudice (i.e., preferred social distance from a minority).     

Sexual Minority Stress,Coping, and Physical Health Indicators

Sexual minorities experience higher rates of several physical health problems compared to their heterosexual counterparts. The present study uses Meyer's Minority Stress Model (Psychological Bulletin, 129(5): 674-697, 2003) to examine physical health indicators among 250 adults who identified as sexual minorities. Study hypotheses include that sexual minority stress is predictive of two physical health indicators (i.e., engagement in a health-promoting lifestyle and number of physical health problems) and that planning (i.e., problem-focused) and social support coping will partially mediate the relationship between sexual minority stress and each physical health indicator. Results showed that as level of sexual minority stress increased, engagement in a health-promoting lifestyle decreased and the number of physical health problems increased. Planning and social support coping did not mediate these relationships; however, as levels of coping increased, engagement in a health-promoting lifestyle increased. These findings have implications for researchers and healthcare professionals in their efforts to promote the physical health of sexual minorities.     

Resident-Led Neighborhood Development to Support Health: Identifying Strategies Using CBPR

Evidence suggests that where people live, learn, work, and play affects a range of health outcomes for children and adults. Differential access to social, economic, and environmental supports puts some community members at greater risk, leading to disparities in health and well-being. The 2014 release of the For the Sake of All report highlighted persistent health disparities for African Americans in St. Louis, Missouri, and their social and economic impacts on the St. Louis region. This study extends this work by developing partnerships with community organizations and neighborhood residents to address health disparities. Community-based participatory research (CBPR) methods were utilized to engage partners in a 10-month research process to address community concerns that impact health. Seven community residents, neighborhood researchers, engaged in workshops to learn about the research process and used techniques to gather information to implement action strategies. Neighborhood researchers selected 14 vacant lots to implement their action plan, which included visions for repurposing the land into a community park, produced a report for dissemination, and organized a community action forum to communicate their findings. This study highlights a promising approach to promote healthy communities and health equity by empowering neighborhood residents using participatory methodologies.     

Identification Reduces Stigma of Mental Ill‐Health: A Community‐Based Study

The stigma surrounding mental ill‐health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill‐health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill‐health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill‐health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill‐health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well‐being.     

“Put a Little Love in Your Heart”: Acceptance of Paternalistic and Ally Political Discourses Both Predict Pro-Roma Solidarity Intentions Through Moral Inclusion

The way politicians talk about minorities institutes the normative context of intergroup relations. We investigated how endorsement of different political discourses predicts donation and collective action intentions by majority members toward the Roma in five European countries. The survey was conducted online using samples demographically similar to the populations of Hungary, Slovakia, Romania, France, and Ireland (N = 5,054). First, results showed that accepting paternalistic discourse versus discourse promoting allyship were not distinguishable; both promoted higher moral inclusion which in turn predicted higher prosocial intentions. Second, donations (i.e., immediate relief) and collective action (i.e., social change action) were driven by identical factors. Third, acceptance of openly hostile political discourse neither predicted moral exclusion, nor lower prosocial intentions. In summary, our research provides important evidence that when it comes to Roma—non-Roma relations, the previously established distinction between solidarity intentions that aim to solidify status relations versus bring about social change is completely blurred, presumably because of the social context in which any positive message communicates moral inclusion challenging the hostile status quo.     

How positive and negative contact relate to attitudes towards Roma: Comparing majority and high‐status minority perspectives

Intergroup contact scholars have recently called for analyzing the effects of negative intergroup contact. In response to this call, we examined the correlates of positive and negative contact with one of the most stigmatized ethnic minorities, that is, Roma. We conducted a study in Bulgaria considering the point of view of the ethnic Bulgarian majority (n = 516) and of Bulgarian Turks (n = 274), an ethnic minority with higher status compared to Roma. Regression analyses showed that positive contact was associated with reduced prejudice and more support for pro‐Roma policies, while negative contact revealed the opposite pattern. These associations did not differ between ethnic Bulgarians and Bulgarian Turks. Moreover, positive and negative intergroup emotions mediated the relationships between positive and negative contact on the one hand and prejudice and policy support on the other. Our study highlights the importance of emotional processes involved in positive and negative intergroup contact experiences and encourages future research to analyze how absolute versus relative status differences shape the effects of positive and negative contact in complex hierarchical societies.     

Intersectional experiences of discrimination in a low‐resource urban community: An exploratory latent class analysis

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N = 1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low‐resource urban community settings.     

Building Leadership,Capacity, and Power to Advance Health Equity and Justice through Community‐Engaged Research in the Midwest

The Health Equity Advancement Lab (HEAL) at the University of Iowa College of Public Health began in 2012 to support students, researchers, and community members interested in tackling persistent health inequities through a community‐based participatory research (CBPR) approach. Using concepts from critical consciousness theory, we developed an approach to building students’, faculty members’, and community partners’ capacity to engage in CBPR to promote health equity that involved immersion in developing CBPR projects. Our paper describes the evolution of HEAL as a facilitating structure that provides a support network and engages diverse stakeholders in critical reflection as they participate in research to advance health equity, and resulting political efficacy and social action. We describe one HEAL‐affiliated research project that employs a CBPR approach and has a strong focus on providing transformative learning experiences for students, faculty, and community members. We highlight challenges, successes, and lessons learned in the application of critical consciousness as a framework that engages diverse academic and community partners seeking to promote health equity. We argue that critical consciousness is a relevant theoretical framework to promote transformative learning among students, faculty, and community partners to promote health equity research in diverse communities.     

Public Health Communication Theory and Strategies for Interpersonal Violence Prevention

ABSTRACT

The article reviews experience and lessons learned from public health communication to identify promising strategies for interventions seeking to promote interpersonal violence prevention. A public health perspective highlights multiple levels of analysis in tandem with concomitant communication theory invoking social, institutional, community, and individual change processes. Points of emphasis include a long-term perspective for social change and the importance of achieving high levels of exposure to communication efforts. Alternative communication strategies such as social mobilization, the use of local media, and media advocacy may foster incremental legal reform and service provision, as well as transformed social expectations and norms.     

Labor Exploitation and Health Inequities Among Market Migrants: A Political Economy Perspective

Previous discourses have recognized institutionalized forms of racism and pointed to structural violence embedded in Canadian policies, institutions, and labor markets. However, there is limited connection of these experiences to health. This paper theorizes a novel connection of health inequities experienced by racialized and immigrant peoples in Canada as a result of globalization and market liberalism. Beginning with a brief historical overview of the slave trade and indentured workers’ experiences, it is suggested that today there is a new variant of slave labor and indentured work. Employing a political economy perspective, this paper suggests the exploitation of “Market Migrants” in Canada. Racialized and migrant workers in Canada experience high levels of precarious work, denizenship, social exclusion, social inequality, and eventually health inequities, which is a result of discrimination experienced by these groups. It reveals that the government has failed to address these issues because of control and lobby through powerful economic and political structures that benefit from the situation as it stands. However, given that there are economic losses to migrant skill underutilization and the growing frustrations manifest in uprisings against these systems of dominance, the current situation is unsustainable and transformation is expected.     

Application of the Minority Stress Theory: Understanding the Mental Health of Undocumented Latinx Immigrants

This paper applies the Minority Stress framework to data collected from an ongoing community-based participatory research project with health and social service agencies in Southeast Michigan. We examine the stressors and coping strategies employed by undocumented Latinx immigrants and their families to manage immigration-related stress. We conducted in-depth interviews with 23 immigrant clients at Federally Qualified Health Care Centers (FQHC) in Southeast Michigan and 28 in-depth interviews with staff at two FQHC's and a non-profit agency serving immigrants. Findings suggest that immigrants face heightened anxiety and adverse mental health outcomes because of unique minority identity-related stressors created by a growing anti-immigrant social environment. Chronic stress experienced stems from restrictive immigration policies, anti-immigrant rhetoric in the media and by political leaders, fear of deportation, discriminatory events, concealment, and internalized anti-immigrant sentiment. Though identity can be an important effect modifier in the stress process, social isolation in the immigrant community has heightened the impact of stress and impeded coping strategies. These stressors have resulted in distrust in community resources, uncertainty about future health benefits, delayed medical care, and adverse mental health outcomes. Findings provide a framework for understanding the unique stressors experienced by immigrants and strategies for interventions by social service agencies.     

Ordinance influences individuals' perceptions towards prospects of social circumstance but not the status quo: An experimental field study on sexual minorities issues in Japan

Scientific evidence shows that institutional decisions can change individuals' private attitudes towards relevant issues. However, little is known about their effect on individuals' perceptions of social norms. This intriguing question has gained the attention of scholars. Nonetheless, the findings are primarily observed only in samples of the Western, Educated, Industrialised, Rich, and Democratic countries, leading to doubts about their generalisability. This study experimentally tested residents' (N = 411) reactions to the new Tokyo ordinance prohibiting discrimination against sexual minorities enacted on October 5, 2018, and tested whether it dispelled self–other discrepancies regarding tolerance towards sexual minorities (i.e., pluralistic ignorance). The results showed that exposure to information about enactment increased future perceptions of support and understanding of sexual minorities. By contrast, private attitudes, perceptions of current social norms, and willingness to speak out did not change. Willingness to speak out was indirectly enhanced through increased perceptions of gaining future support. Furthermore, Tokyo residents overestimated other residents' negative attitudes towards sexual minorities. However, even when informed of the new ordinance, this self–other discrepancy in intolerance towards sexual minorities was not corrected. These findings suggest that institutional decisions can shape the perception of social norm change in the future beyond Western countries.     

Making the Connections: Community Capacity for Tobacco Control in an Urban African American Community

Developing community capacity to improve health is a cornerstone of community-based public health. The concept of community capacity reflects numerous facets and dimensions of community life and can have different meanings in different contexts. This paper explores how members of one community identify and interpret key aspects of their community’s capacity to limit the availability and use of tobacco products. Particular attention is given to examining the interrelationship between various dimensions of community capacity in order to better understand the processes by which communities are able to mobilize for social change. The study is based on qualitative analysis of 19 in-depth interviews with key informants representing a variety of community sectors in Harlem, New York City. Findings indicate that the community is viewed as rich in human and social resources. A strong sense of community identity and connectedness underlies this reserve and serves as a catalyst for action. At the time this study was conducted, all authors were at Columbia University Mailman School of Public Health.     

Capturing Dynamic Processes of Change in GROW Mutual Help Groups for Mental Health

The need for a model that can portray dynamic processes of change in mutual help groups for mental health (MHGMHs) is emphasized. A dynamic process model has the potential to capture a more comprehensive understanding of how MHGMHs may assist their members. An investigation into GROW, a mutual help organization for mental health, employed ethnographic, phenomenological and collaborative research methods. The study examined how GROW impacts on psychological well being. Study outcomes aligned with the social ecological paradigm (Maton in Understanding the self-help organization: frameworks and findings. Sage, Thousand Oaks 1994) indicating multifactorial processes of change at and across three levels of analysis: group level, GROW program/community level and individual level. Outcome themes related to life skills acquisition and a change in self-perception in terms of belonging within community and an increased sense of personal value. The GROW findings are used to assist development of a dynamic multi-dimensional process model to explain how MHGMHs may promote positive change.     

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.     

Decision-Making in Mental Healthcare: A Phenomenological Investigation of Service User Perspectives

As Victorian asylums closed down in the United Kingdom, community mental health services were set up to support patients in exercising choice and freedom; in finding a place in society. The success of these services has been questioned, so further policies have been introduced in an effort to protect rights and improve social inclusion. However, capacity to make decisions has been interpreted as no more than a process of rational mental calculation. This article reports on a phenomenological study that explores the decision-making experiences of three men who have endured psychosis. It is not only associated with choice and freedom but also with responsibility, blame, and social exclusion. These men appear to have faced common existential dilemmas, but have sought to express emotional will in conflict with other people and have, perhaps, been placed under more social pressure and become more isolated as individuals, while enduring experiences that are difficult to make meaningful for others. It seems that, paradoxically, efforts have been made to empower these men by controlling them, and medication has been imposed on them so as to regulate thoughts and moods, in attempts to serve their best interests.     

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid‐1980s to mid‐2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re‐engaging with community mental health and fostering well‐being, inclusion, and liberation of adults experiencing serious mental health challenges.