• Dr. Jack Geiger (2nd from Left), founder of the nation's first community health center visited Puentes de Salud in February 2013 and is pictured with its three founders, Drs. Steve Larson, Matt O'Brien, and Jack Ludmir.

Research

Puentes de Salud has produced a growing body of research designed to improve general knowledge about health and illness in U.S. Latinos, and to demonstrate the effectiveness of Puentes de Salud's programs. This work has focused on on important topics in Latino health, including obesity, diabetes, nutrition, and cervical cancer prevention. Ultimately, we hope our research will help generate best practices to guide the care of similar communities nationwide. Our research has taken the form of peer-reviewed journal articles, scientific presentations, student theses and unpublished reports. Examples are provided below.



The Association Between Obesity and Health-Related Quality of Life Among Urban Latinos
Karolyn A. Wanat, MD; Carrie L. Kovarik, MD; Sara Shuman, MPH; Robert C. Whitaker, MD, MPH; Gary D. Foster, PhD; Matthew J. O’Brien, MD, MSc

This study sought to quantify the burden of obesity in the South Philadelphia community by measuring the height and weight of 202 Latinos recruited in community venues. Data were collected by Puentes de Salud's community health workers, or promotoras, using smartphones. Participants' body mass index (BMI) was used to examine the impact of obesity on their quality of life. The prevalence of overweight and obesity in South Philadelphia Latinos was 83%, which is higher than national estimates (77%). The principal finding of this study was that Latinos' quality of life was only minimally affected by their obesity status, which is contrary to what similar research has shown in other demographic groups. This finding has implications for how we design weight loss programs for Latinos and counsel Latino patients in clinical settings.

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Diabetes-Related Behaviors in Latinas and Non-Latinas
Matthew J. O'Brien, MD, MSc; Adam Davey, PhD; Victor A. Alos, DMD, MPH; Robert C. Whitaker, MD, MPH

Certain dietary and physical activity behaviors have been associated with the risk of developing type 2 diabetes, yet little is known about how common these behaviors are among Latinas (Latino women). The purpose of this study was to compare the prevalence of the following diabetes-related behaviors in Latinas and non-Latinas: walking, moderate to vigorous physical activity, and consuming fried potatoes, sugary drinks, desserts, and fast food. We found that Latinas are almost twice as likely to consume sugary drinks and fast food than non-Latinas. These dietary behaviors may be the focus of interventions to prevent diabetes in Latinas.

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Community Health Worker Intervention to Decrease Cervical Cancer Disparities in Hispanic Women
Matthew J. O'Brien, MD, MSc; Chanita Hughes Halbert, PhD; Rebecca Bixby, RN; Susana Pimentel; Judy A. Shea, PhD

The use of community health workers, or promotoras, is considered a potential strategy for eliminating racial and ethnic health disparities. This study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in the local Hispanic community. Four promotoras led a series of two workshops with community members covering content related to cervical cancer. Follow-up data revealed significant improvements in all outcome measures, including receipt of Pap smear screening, cervical cancer knowledge, and self-efficacy. This study underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them.

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Role Development of Community Health Workers: An Examination of Selection and Training Processes in the Intervention Literature
Matthew J. O'Brien, MD, MSc; Allison P. Squires, PhD; Rebecca A. Bixby, RN; Steven C. Larson, MD

Interpreting the results of community health worker (CHW) intervention studies and replicating their findings requires knowledge of how CHWs are selected and trained. A summative content analysis was performed to evaluate the description of CHW selection and training in the existing literature. Reporting of selection and training processes for CHWs was found to be inconsistent. Training processes for CHWs were more frequently reported, demonstrating wide variation in length and content. Consistent reporting of CHW selection and training will allow consumers of this research to better interpret study findings. A standard approach to reporting selection and training will also more effectively guide the design and implementation of future CHW programs.

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Becoming a Promotora: A Transformative Process for Female Community Health Workers
Allison Squires, BSN, MSN, PhD; April Campos, BS; and Matthew O'Brien, MD, MSc

This study sought to explore the effects of assuming a new role on Latina community health workers (CHWs) participating in a cervical cancer prevention program. Through a series of in-depth interviews with the participants, the researchers explored the process and effects of assuming and enacting the CHW role. Findings showed that assuming the role had transformative effects on individuals, allowing them to reconcile disparate aspects of their own immigrant identities. The findings have multiple implications for designing prevention programs employing CHWs and strengthening immigrant communities.

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Understanding Participation of Latina Immigrants in a Cervical Cancer Prevention Program in South Philadelphia: Thinking Beyond Culture
Paola Abril Campos Rivera, BS (senior thesis)

This study explores women's participation in a cervical cancer prevention program directed by community health workers, or promotoras. Using 12 in-depth interviews with participants and promotoras, this study sought to disentangle cultural, migration-related determinants and structural factors of women's participation in this cervical-cancer prevention intervention. It was widely assumed that lack of information and cultural barriers were to blame for low Pap smear screening rates and lack of program participation among Latinas. This study found evidence that challenged the widespread stereotypical characterizations of Mexican immigrant women who were not readily willing to participate in a cervical cancer prevention workshop.

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Disparities in Patient Satisfaction Among Hispanics: The Role of Language Preference
Matthew O'Brien, MD, MSc, and Judy Shea, PhD

Hispanic and Spanish-speaking patients experience lower satisfaction with their health care when compared to white and English-speaking patients. This study attempts to clarify the relationship between language preference and patient satisfaction in Hispanics. Study participants were recruited from two local clinics that serve an exclusively Hispanic population. Patient language preference was not a consistent predictor of satisfaction in this cohort of Hispanic patients receiving linguistically competent primary care. The analysis of local data provided a crude adjustment for health care quality that is missing from previous research.

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Addressing Health Disparities Through Patient Education: The Development of Culturally Tailored Health Education Materials at Puentes de Salud
Isobel Harvey, RN, MSN, (masters thesis) and Matthew O'Brien, MD, MSc

The availability of culturally appropriate written health information is essential for promoting health in diverse populations. The authors conducted a needs assessment at a clinic serving recent Latino immigrants, focusing on patients' health and previous experiences with written health information. Based on these results and a literature review, Puentes de Salud developed 10 Spanish language brochures to better serve the target population. This article outlines the process of developing and implementing this intervention, which can serve as a model for similar projects targeting diverse populations.

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Mujeres en Moción: A Community Health Education Class
Jen Abracinzkas, BA, and Tanya Keenan, BS (Albert Schweitzer Fellows report)

This project aimed to extend Puentes de Salud's activities beyond the health clinic into the realm of health promotion and disease prevention. Puentes de Salud started a sustainable program of classes to teach community members about the most common chronic diseases and about lifestyle behaviors necessary to prevent them. Although a systematic evaluation of effectiveness was not conducted, participants' feedback indicated that the program motivated lifestyle modifications and enhanced Puentes de Salud's long-term presence in the South Philadelphia Latino community.

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The Role of Community-Based Participatory Research to Inform Local Health Policy: A Case Study of Puentes de Salud
Matthew O'Brien, MD, MSc, and Robert Whitaker, MD, MPH

Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the local level. The authors present four mechanisms by which CBPR might increase the ability of researchers to impact health by informing local policy. For each of these mechanisms, the authors describe an example from a CBPR project one of them has conducted. Considering the challenges and opportunities of conducting CBPR, future efforts will help describe how this emerging research paradigm can complement traditional health services research to most effectively inform health policy at multiple levels.

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Knowledge, Beliefs and Practices of Latino Type 2 Diabetics in South Philadelphia
Heidi Swan, MPH (masters thesis); Ricky Brawer, PhD; Matthew O'Brien, MD, MSc

The goal of this study was to collect information about the knowledge, beliefs and practices among Puentes de Salud patients with type 2 diabetes. A total of 12 patients participated in two focus groups stratified by level of glucose control as determined by A1c levels. Major themes from the analysis included factors that mediate glycemic control, life changes, causes, symptoms and reactions to diagnosis. Participants also provided information about their perceived needs in the clinic and in future programming. Information collected in this project was shared with Puentes de Salud staff to improve care of their patients with type 2 diabetes and to design future programs to meet the specific needs of this community.

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The Latin American Diet Pyramid: Serving the Latino Population?
Elena Blebea, BA (senior thesis)

This study evaluates the effectiveness of the Latin American diet pyramid as a nutritional tool and a dietary guideline for Latinos in the U.S. The study takes place in South Philadelphia and consists of focus groups, interviews and a NEMS-based survey at a local grocery store. The primary hypothesis was that the Latin American diet pyramid is ineffective, because it does not fully account for the socioeconomic and cultural structures in the U.S. Latino population. This hypothesis was only partially upheld based on the study results. Some cultural and educational barriers could perhaps best be addressed through revisions to the pyramid, a nutrition class based on the pyramid, and the establishment of market vendors in Latino communities, similar to Philadelphia's Italian market.

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South Philadelphia Community Food Assessment
Maya Gutierrez, BA, MA; Margot Stern, BS; Emily Mitnick, BA, et al.

This study sought to describe the food environment in the South Philadelphia Latino community served by Puentes de Salud. Using mixed methods, this study reports on the community's access to healthy foods, the types of food outlets available (restaurants, corner stores, grocery stores, markets), and the nutrition practices of community members. The study was designed to help Puentes de Salud refine existing nutrition programs and design new programs to meet the unique needs of the South Philadelphia Latino community.

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Philadelphia as a Re-emerging Immigrant Gateway: An Exploration of Mexican Entrepreneurship and Its Economic Value
Oscar Benitez, BA (senior thesis)

This report describes and explains the economic development of Mexican immigrant entrepreneurs in South Philadelphia. Research examines the strategies, challenges and achievements of small business owners in an emerging ethnic economy that has revitalized commercial corridors. The author presents recommendations for local government officials and other public and community organizations devoted to the advancement of the South Philadelphia economy. The results provide other cities with the opportunity to replicate community initiatives and government support to assist immigrant entrepreneurs in maximizing their economic potential.

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A Participatory Model for Community Health Assessment in the South Philadelphia Latino Immigrant Community
Rebecca Bixby, RN

The first piece of scholarship conducted by Puentes de Salud, this needs assessment laid the groundwork for the efforts outlined on this Web site. It describes the demographic changes in the South Philadelphia Latino population, the existing safety net of social and medical services available to this growing community, and Puentes de Salud's future plans to meet the community's needs.

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Modern Public Health Systems
Lisa Chacko, MPH, and Sara Chacko, MPH

This chapter in the textbook "Public Health Foundations: Concepts and Practices" describes the social-ecological model of health, which identifies the diverse determinants of health and the relationships among them. The authors—one of them a Puentes de Salud volunteer—present Puentes de Salud as a practical example of the social-ecological model in action. Puentes de Salud's model includes the provision of primary health care, basic dental care and screenings, and referrals to low-cost or free specialist care in the community, along with health education programs, community outreach, and training of future health care professionals.



Puentes de Salud Pediatric Needs Assessment
Julie Linton, MD

This needs assessment was developed to identify and document the South Philadelphia Latino community's priorities for pediatric care at Puentes de Salud. The project included evaluation of the changing demographics of the Latino pediatric population, followed by discussion with local stakeholders to identify the children's medical needs. The project also assessed the community's use of the Internet and e-mail to determine whether health promotion through electronic media would be appropriate or effective for this audience. The ultimate goal of this project was to lay the foundation for creating a robust pediatric medical home at Puentes de Salud.

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Juntos Project: Needs Assessment
Julie Linton, MD, and Carly Levy

Conducted in 2004, this needs assessment was the earliest attempt by Puentes de Salud volunteers (in partnership with WOAR and Juntos) to establish an overview of the rapidly growing Latino immigrant community in south Philadelphia.  It served to identify and document the South Philadelphia Latino community's use of health care facilities, as well as the community's needs and priorities.  

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