Enhancing Health Equity: The Potential of Peer Health Ambassadors


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  • How disadvantaged become more marginalized in the health system:LanguageAccess - Language barriers affect ability to find information and services for immigrantsQuality - In a healthcare setting, language barriers impede in trust building (can even prompt negative caregiver biases), and with conveying important information between patient and caregiverCulture/ReligionMuslim women in Newfoundland report feeling embarrassed, judged, and misinterpreted based on their religious practices, and they were unable to receive health guidance for religious practices such as fastingStrong traditional Chinese cultural identity is linked with challenges in adapting to Western health practices and accessing health servicesRaceAboriginal people are less than half as likely to receive renal transplants compared to other races, resulting in increased mortality ratesEthnographic study shows that racial discrimination is hidden in everyday healthcare encounters and is often an unconscious process of profiling and discrimination despite caregivers’ insistence that they treat their patients fairly and without prejudiceSESPhysicians’ perceptions of patients with low SES is more negative than perceptions of other patientsSexualityRoughly ¼ of bisexuals do not disclose their sexual orientation when visiting healthcare providers (citing fears about confidentiality, privacy, negative judgements, feeling awkward, lack of understanding, humiliation, and being treated poorly)Geography- Neighbourhoods with higher poverty rates are likely to house fewer social and healthcare services and organizations (this is a good case for community-based services)AgeAlthough youth engage in a wide variety of sexual activities, 83% have never accessed clinical sexual health care
  • Results such as:Able to get marginalized communities to engage in healthier behaviours such as cancer screening and breast feedingAble to reduce negative health consequences such as overdoses and assault (Vancouver Mobile Access Project for female sex workers). Peer workers reported that once the women realized the staff were their peers, they opened up more, they were more compassionate and even showed concern for the wellbeing of the peers.Services grow in popularity/demand
  • Many names: Peers, buddies, health talkers, layperson, navigator, etcTraining and expertiseIntensity and length of trainingDifferences in personal history/education in health subjectCompensationTend to be volunteers, but also many who are paid honorariums, some are eventually hired as staff
  • Financial CompensationThese services are targeting at-risk and vulnerable populations, therefore true peers may be facing difficult life circumstances, such as poverty.Compensation implies their work is considered valuable to the program and this can increase peer worker self-efficacyTraining/support/mentoringNot just so that they have the expertise needed to deliver quality services, but also so that the proper structures are in place to support peers. Peers can identify problems to a dedicated facilitator who works closely with and is trusted by the peersPeer work is often used as a stepping stone for career advancement, the high turnover rate should be accounted for so that peers are not overburdened and so that care is seamless to clients who may have developed personal and trusting relationships with peersClear roles/flexibilityClear role descriptions that allow for continuous growth and change given complex environmentsAccommodating needs of peers and communities – such as irregular hours, specific types of foodParticipation of peers in program/service planning/developmentThey can identify community’s needsThey can identify best practices for engaging clientsThey can inform staff about their own needs as peer workersRigorous quality assurance at every stageRegular evaluations/monitoring and amendmentsPro
  • Peer life-stageSometimes peers haven’t been successful with implementing positive changes in their own health and lifestyles. They may experience difficulties leading their community by example, or their life circumstances may pose challenges to their ability to function in a working environmentBreach of personal boundariesIf peers are relating to clients through shared experience with drug use, for example, some interactions may be highly personal and it may be difficult to draw the line so that their personal boundaries aren’t breached. Support peer needs, service demands and client expectationsThis work is very dynamic and frequently changes, systems may not be put in place to meet needsClients may require more variety in services offered to meet their needsPeers may require different sets of materials based on their own health promotion stylesClient preferencesPeers are not always they answer, community may not trust them as expertsDelivering in the community not always best if community believes specific health services should be delivered in clinical settings
  • MarketingDifferent channels of marketing services need to be explored, some communities distrust outside sources of health information (e.g., cultural health beliefs may be adverse to Canadian health practices, some populations may not trust conventional health service marketing if their health behaviours are illegal, such as drug users and sex workers)Sometimes word of mouth is good, with flyers given out by peers, sometimes after hours marketing is required, the marketing needs to take place within the communityUnstable FundingUsually grant-based funding, dismantles initiatives before maturityScaling upContext is so crucial – can be hard to ‘spread’Local and small is one of unique features and often key enabler -> spread goal; may not be to get bigger, but to have more institutions and programs have appropriate peer components
  • Enhancing Health Equity: The Potential of Peer Health Ambassadors

    1. 1. Bob Gardner and Estelle Sun Canadian Public Health Association Annual Conference, June 22, 2011 ENHANCING HEALTH EQUITY: THE POTENTIAL OF PEER HEALTH AMBASSADORSwww.wellesleyinstitute.com 1
    2. 2. Problem: Health InequitiesPervasive inequities in health outcomes are rooted in social determinants of health and systemic inequalitiesThe most disadvantaged in SDoH terms can become more marginalized in the health system • Language • Sexuality • Culture and Religion • Geography/Distance • Socioeconomic Status • Age • Race 2
    3. 3. POWER Study Gender and Equity Health Indicator Framework Highlights1. How the structure, resources and resilience of communities mediate the impact of SDoH2. Why we need to take SDoH into account in health service planning and delivery 3
    4. 4. Building Solutions → Comprehensive Health Equity StrategyNeed comprehensive strategy to address the foundations and impact ofhealth inequities → + Macro social and economic policy to reduce overall inequality • from childcare through improving precarious employment to education + Comprehensive community initiatives to build resources and resilience + Community mobilization to push for necessary policy changesEven though roots of health disparities lie in far wider social and economicinequality, how the health system is organized and how services and careare delivered is still crucial to tackling health disparities, including: • Reducing barriers to equitable access to high quality care • Targeted interventions to improve the health of the poorest, fastest • Up-stream investments in primary and preventative care directed to most vulnerable • Delivering a full continuum of services in coordinated way at community/local level 4
    5. 5. Part of the Solutions: Community-Driven InnovationNeed innovative community-based service delivery andpartnershipsPeer Health Ambassadors• Members of the community, from the community• Working with established healthcare providers to improve access and quality of care for targeted populations 5
    6. 6. Our ResearchPurpose• Survey the range and impact of Peer Health Ambassadors• Assess their potential to meet needs of marginalized populations• Identify key success conditions and enablers to realize this potentialMethods• Review of literature• Key informant interviews with 10 Toronto community organizations currently working with peer-based models 6
    7. 7. Findings: Great PotentialGeneral congruence between literature review andkey informant interviews:• Peer Health Ambassadors are a promising model for improving health equity through eliminating barriers to health care and improving engagement• Marginalized groups prefer healthcare providers who have personal experience with their problems, who understand their viewpoints, and who share key traits (race, gender, religion, sexuality, cancer, drug use, etc.)• When community impact is reported, the results are generally very positive 7
    8. 8. Findings: Characteristics of Peer Health Ambassadors• Wide range and no clear definitions of ``peer`` • Varies in level of expertise and “peerness”• Three broad areas: • navigating the system • health promotion • integrated into comprehensive service provision• Volunteers vs. paid staff• Tend to be women 8
    9. 9. Findings: Facilitators to Effectiveness and Impact• Financial compensation• Initial and ongoing training/support/mentoring for peers• Clear roles and division of labour + flexibility to accommodate dynamic needs of both peers and communities being served• Participation of peers in program or service planning and development• Rigorous quality assurance at every stage• Program evaluation to improve practices 9
    10. 10. Findings: Barriers• Peer life-stage, ability to adapt their own health and lifestyle to work environment• Breach of peers’ personal boundaries by clients and co-workers, because of the highly personal nature of this work• Organizational capacity to support peer needs, service demands and client expectations• Client preferences for credentialed professionals or specific delivery settings 10
    11. 11. Findings: Barriers (cont’d)• Resistance from professionals or institutions to community-based delivery• Mainstream marketing doesn’t work for marginalized populations• Unstable funding• Scaling up to larger projects 11
    12. 12. Realizing the Potential of Peer Health Ambassador Initiatives• Enlist users in planning and development• Provide ongoing training and support, driven by peer and community needs• Provide financial compensation, even during training• Allow for adaptability and flexibility of training and program to suit the needs of peer workers and clients• Monitor and evaluate for quality• Market the services using mediums that can reach the target population• Actively pursue alternative funding sources 12
    13. 13. Key Messages• Need comprehensive strategy to address health inequities• Part of this is ensuring equitable access to high-quality care for all – even the most vulnerable and isolated• Peer ambassador type initiatives have shown great potential in being able to reach, support and involve marginalized populations• In line with key themes of this conference: • Address complexity of social determinants of health through flexible and creative policy, programs and collaboration • Build on potential of community initiatives and innovation • Build on community empowerment and engagement 13
    14. 14. THANK YOU Please visit us atwww.wellesleyinstitute.com