Students as Community Vaccinators: Implementation of a Service-Learning COVID-19 Vaccination Program

Background: Service-learning is an integral component of medical education. While the COVID-19 pandemic has caused massive educational disruptions, it has also catalyzed innovation in service-learning as real-time responses to pandemic-related problems. For example, the limited number of qualified providers was a potential barrier to local and national SARS-CoV-2 vaccination efforts. Foreseeing this hurdle, New York State temporarily allowed healthcare professional trainees to vaccinate, enabling medical students to support an overwhelmed healthcare system and contribute to the community. Yet, it was the responsibility of medical schools to interpret these rules and implement the vaccination programs. Here the authors describe a service-learning vaccination program directed towards underserved communities. Methods: Weill Cornell Medicine (WCM) rapidly developed a faculty-led curriculum to prepare students to communicate with patients about the COVID-19 vaccines and to administer intramuscular injections. Qualified students were deployed to public vaccination clinics located in underserved neighborhoods across New York City in collaboration with an established community partner. The educational value of the program was evaluated with retrospective survey. Results: Throughout the program, which lasted from February to June 2021, 128 WCM students worked at 103 local events, helping to administer 26,889 vaccine doses. Analysis of student evaluations revealed this program taught fundamental clinical skills, increasing comfort giving intramuscular injection from 2% to 100% and increasing comfort talking to patients about the COVID-19 vaccine from 30% to 100%. Qualitatively participants described the program as a transformative service-learning experience. Conclusion: As new virus variants emerge, nations battle recurrent waves of infection, and vaccine eligibility expands to include children and boosters, the need for effective vaccination plans continues to grow. The program described here offers a novel framework that academic medical centers could adapt to increase vaccine access in their local community and provide students with a uniquely meaningful educational experience.

Navigating the Boundaries of Youth Violence Prevention and Reduction: Reflections on Power in Community Engaged Scholarship

Community-engaged scholars grapple with power asymmetries in community-university partnerships, generally working from the assumption that deliberate practices are required to moderate the researchers’ power vis-a-vis that of the community. In this article, we suggest that this dyadic framing masks the complexity of power dynamics within communities, of which the university is just one part, and examine how power is negotiated in the boundary zones of a partnership. We use Third Generation Cultural Historical Activity Theory (CHAT) as a conceptual framework to analyse the structural and cultural dimensions of the boundary zone in which research, learning and action in our partnership occurred (Engeström 1996). A brief story sheds light on our boundary work which uses research and data to span, broker and shake institutional boundaries for the purpose of youth violence prevention and intervention. Our analysis illuminates the potential and limitations of our power to foster transformational change. It also allows us to show that underestimating power differentials and the diversity of values and cultures within an organisation and between a university and a community partner, and certainly across multiple institutions in the case of a cross-sector partnership, can slow down and even thwart work to address societal problems.

The African Immigrant Dementia Education Project: A Community-University Partnership

The African Immigrant Dementia Education project is a community-university partnership with the goal of developing a culturally tailored dementia education program with African immigrants in Minnesota. In collaboration with our community partner (African Career, Education & Resource, Inc.), a project advisory board that features professionals and family members from the African immigrant community was assembled and its first meeting was held in February 2021. Preliminary discussions about content, mode of delivery and cultural considerations of an eventual dementia education intervention have begun. This presentation will offer details on the process of working with an advisory board and community partner to identify and culturally tailor an evidenced-based dementia education curriculum for a unique cultural group. Also, we will present challenges encountered during this process and offer suggestions and strategies to promote successful researcher-community partnerships.

A Remote Music-Based Service-Learning Project to Support Isolated Older Adults in Long-Term Care

Growth of the aging population warrants a commitment to teaching students to work effectively with older adults. In an online university course focused on inclusive music practices, students engaged in an extensive service-learning project to enhance course learning objectives and increase sensitivity to disability, social justice, and inclusion issues across the lifespan. Based on community needs, one student aimed to reduce isolation among older adults living in a long-term care facility. The student selected this target and population because of the detrimental effects of isolation on psychosocial, cognitive, and physical well-being; and reduced access to interactive programs and services among older adults living in residential facilities during the COVID-19 pandemic. Components of the project included a service-learning proposal, an annotated bibliography, an interview with the community partner, three activity designs, and a reflective essay. Based on existing research regarding interventions used to reduce isolation among older adults, the three activities the student designed were music bingo, interactive singing, and stretches to music. Throughout the service-learning process, the student consulted the community partner to ensure relevance of the activities. Principles of Universal Design for Learning (UDL), such as providing multiple visual and auditory means to engage with materials, enhanced accessibility of the activities. In this presentation, the student and course instructor will reflect on this case experience and the value of service-learning to foster professional skill development, engaged citizenship in working effectively with older adults, and an appreciation of the need for justice, equity, and fairness for all community members.

GWEP TAG-TEAM Response: COVID-19 Health Disparities in Orange County, California

Health disparities follow zip codes, and in Orange County, CA, both COVID-19 cases and deaths are highly concentrated in our diverse geriatric populations in Santa Ana (44,075) and Anaheim (40,984) where our two UCI Federally Qualified Health Centers (FQHCs) are located, and Garden Grove (16,174) and Buena Park (7,581), where University of California Irvine (UCI) TAG-TEAM GWEP community partner FQHCs are located. Collectively, our FQHCs serve diverse populations, with 83-88% of patients identifying as Hispanic/Latino or Asian. As we support these clinics in becoming Age-Friendly Health Systems, UCI’s GWEP pivoted to provide COVID-19 education in the form of multi-lingual materials and videos available in Spanish, Vietnamese, Korean, Mandarin, and Farsi. Additionally, through our Age-Friendly Geriatrics Tele-ECHO Series we are working to build Mental Health care competencies among these FQHC providers since the pandemic morbidity and mortality disparities have resulted in a profound mental health crisis in our communities.

Lessons From a Community Driven Experiential Public Health Course

Applied practice opportunities are essential in both undergraduate and graduate public health programs, and are emphasized in the 2016 changes to the Council on Education for Public Health (CEPH) accreditation requirements. To generate and implement solutions to challenges our communities face, there is an increased need for public health training that includes both rigorous coursework and experiential learning opportunities. We share here a framework and scaffolding from a class that has provided a supportive structure for public health students to conduct applied practice activities in response to expressed needs of community organizations. Guiding Principles: The practicum is grounded in theories of practice-based learning, community based participatory research, and community engaged research with a vision of preparing students to participate in community knowledge generation partnerships to more effectively address health disparities. Lessons learned: Advance planning creates a foundation for success. Community partner and student interests are aligned; teams share the common goal of promoting sustainable long-term impact through their projects. Students are prepared for success through the development of instrumental tools (e.g., logic models, program impact pathways, and work plans) that guide project development and implementation. Students learn to adapt to evolving partner needs. Students have a unique learning experience that is practice-based. Future work to understand key functions of different course elements will add quantitative metrics to the existing qualitative metrics in the preceptor evaluation, work with other practicum instructors to develop common best practices and will include a qualitative analysis of student reflections.

Adoption of an Evidence-Based Intervention for Mammography Screening Adherence in Safety Net Clinics

Through an academic-community partnership, an evidence-based intervention to reduce mammography appointment no-show rates in underserved women was expanded to safety net clinics. The partnership implemented four strategies to improve the adoption and scale-up of evidence-based interventions with Federally Qualified Health Centers and charity care clinics: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers. The development of academic-community partnerships can lead to successful adoption of evidence-based interventions particularly in safety net clinics.

Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping with Palliative-Stage Cancer: Protocol for a User-Centered Design Study (Preprint)

BACKGROUND Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk for inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile applications (“apps”) to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed with families with cancer. OBJECTIVE The aim of this study is to develop an mHealth app prototype for coordinating flexible and trusted in-home respite care services, provided by nurses to families coping with palliative-stage cancer in Québec, Canada. METHODS This user-centered design research comprises the core component of the iRespite Services iRépit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments, and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proof-of-concepts for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof-of-concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. RESULTS We anticipate that preliminary results will be available by Spring 2022. CONCLUSIONS An app prototype will be developed that has enough complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services rendered to families with palliative-stage cancer in Québec, supporting death at home, which is where most patients and their families wish to be.

An Exploratory Study of the Community Impacts of Service-Learning

Research on community impacts from service-learning has been scarce, yet this area is worth exploring in order to understand how and why service-learning can make a difference. The current research sought to validate a conceptual framework (Lau & Snell, 2020), which categorizes the impacts of service-learning on community partner organizations (CPOs) and on end-beneficiaries. Under the framework, impacts on end-beneficiaries can arise directly from service-learning interventions, but can also arise indirectly as a result of impacts on CPOs. For the research, semi-structured, one-to-one or focus group interviews were conducted with 13 CPO representatives, seeking their perceptions of positive and negative impacts of service-learning. Most described impacts were positive, including, for CPOs: achieving project goals to further the CPO’s mission; augmenting resources of the CPO; and gaining knowledge, insights, ideas and techniques. These positive impacts for CPOs appear to reflect three factors: alignment between service-learning project goals and the CPO’s mission; mutual recognition of students’ potential for transferring knowledge from universities to CPOs; and mutual understanding of students’ status as semi-outsiders, free to challenge existing practices or systems. Further studies can explore impacts from the end-beneficiary's perspective, and adopt longitudinal and action research approaches.