Day 2- Increasing Health Equity and Improving the Service Experience for Under-Served Latina/x/o Communities in Arizona

— Thank you and let us pull-up the slides and welcome you to our presentation

• Talking about work in increasing health equity and improving service experience in Arizona

— A little about us, beyond the bio you’ve heard

• Done every kind of community engagement and have been helping groups inspire and elevate voices

— We are here to tell you about our collaboration and practical ways to center equity through design process, and working with community partners, and making design process better

• Discuss lessons learned, and actionable takeaways for equitable initiatives
• Outlook how deep engagement can create culturally resonant and sustainable solutions

— Some context about the work

— Pima County in Arizona deals with refugee or migrant population crossing the Mexican border into the United States, and has mix of seasonal residents and year-round residents more vulnerable

 

— Project existed in complex climate in conservative state, which required thoughtful community engagement

— Funded for four million dollars by department of health and human services and improve health literacy among underserved population, defined as follows:

• 20-45 childbearing age, and vaccine hesitancy among pregnant individuals
• Latinae as inclusive term used for this group

— Supported by key enablers at all levels

— Federally, executive orders emerged that prioritized racial equity, and customer-centric service delivery

• Racism and income inequality also labeled as public health emergencies by Pima County

— Bringing HCD for behavioral science, and impactful equity focused solutions and encountered challenges in work, with timing as major issues

— Covid-19 not pressing at that time, and entrenched mistrust from predatory healthcare systems, and communication gaps

• Embrace new approach for health literacy and NIH in 2020 and how people find and understand health information

— Shared organization and responsibility and get orgs on same page

— Built community of practice (CoP) as goal of project, and recruited trusted community members and evaluation team from University of Arizona, and external consultants

• Picked local partners consisted trusted messengers within Latinae and center lived experience in process

— Integrate individuals to define own engagement parameters

— CoP built credibility quickly and community level excited in process

• Feedback snowballed to build efficacy

— What was it like to work with CoP from designer perspective?

• Had deep expertise for HCD globally, and applied to U.S. client and comprehensive work

— Team of NYC-based designers, and access to CoP was important and fully leverage with full range of players and local ecosystem

• Considered systems as living embodiment

— Lens chosen was on contributions of CoP and slides will outline details and learnings along the way, with a quick overview of process and had luxury to run separate design sprints, with foundational resources

• Community members and supporting them

— Co-creation and facilitated workshops and emergent ideas refined prototypes prior to pilot

— Sustained in design sprints, but members of CoP took ownership of projects toward end

— Thought concretely about how to compensate community members

• Community members are experts in own lived experience, but institutions lag in recognizing value

— Embed directly into budgeting practices, viewing budget as moral document, and built incentive plan beyond standard rates for public health setting and meant securing approvals from funders and administrators and anticipated it

• Faced invisible red tape of barriers like payments methods, and safeguarding them
• Faced each of barrier head-on, and efforts didn’t stop there and keep payments below tax reporting threshold
  • Honored experience in valuable and tangible way

— Foundational research engaged 50 participants. Consulted them with research in goods and then provided outreach support to recruit participants and engage with three groups

• Learnings sound obvious, but more intentional engagement needed to bring community long

— Spectrum from least to most participatory

• HCD, no CoP, and decision making program for client organization
• Community representatives are not involved in key parts of process from problem definition and demands deeper level of engagement
  • Need to refine process for non-designers by reducing jargon and periodic share-outs and reinforce what lies ahead and outline timelines

— In-person workshops for enabling decision-making activities

— Co-creation, used and shared out from research for in-person and workshop opportunity areas from research, and 15 opportunity areas and created from research findings

• All members of COP and take forward into creation and translate into Dahlberg team for brainstorming sessions and key learnings to bring CoP along for design process
  • Need comfort with ambiguity and hard to grasp and concrete to serve

— Building trust with community and get feedback from CoP and inject expertise with communities served in tor prototypes

• Prototypes tested and distributed along CoP
• Refined prototypes into culturally competent interventions for piloting

— Series of additional sessions and each capacity to take on pilot

— Two distinct pilots emerged, and alignment with clinical CoP members and interventions in clinical setting: a class training, rest of interventions and experience for setting goals with patients in wait-room and access resources

• Promotora as community health work empowered to make decisions

— Set of Covid-19 interventions and easy to follow checklist and looking at complex US system, along with CoP members and involved healthcare navigation workshop and optional chat for further guidance

• Facilitated by lived experience in Latinae community

— Brought pilot to life, as people adopted interventions and integrated tools that felt natural and effective in real-time, and create messages that aligned with audiences

• Final implementation offices, and community solutions and balance flexible innovation with realistic expectations that recognized capacity limits of organization

— Reflections revealed transformative nature of work

— People felt more confident navigating healthcare systems, and workshops brought families together, and increasing health literacy

• Gains in patient confidence in navigating healthcare, and higher rates of vaccine needs

— Practicioner communication improved and new channels for bi-directional communication established

— Org successes included

• Three health promotoras experiments and focused interactions in wait-room and beyond and better tech and health literacy
• HCD training program and Pima County HCD supporting naturalization process for local immigrants

— Governments hungry for HCD are mindful of incremental capacity for change

• Double-time lines for each phase as extensive community engagement will shift plans and schedules
• Trusted local communication channels and efficacy of outreach and bring community partners along with
  • RFP reflecting nothing about us without us, and had staff of understanding local context and community partnerships and dynamics for under-resourced

— Alexia learned

• Community members early, and cycles of HCD, and local promotoras working there in Tucson with YMCA
• Tapped resource for every phase after that and our version of promotora model and decision and accessible with avoiding complicated language and hire locally with lived experience
  • Leverage people from community

— Collaborative effort impactful, by making participation accessible (5th Grade reading levels), irresistible (feed the people participating in the study) , and sustainable (nurture long-term relationships) along with access to program reports

— Thanks so much for joining us and would love to join and help you out

• Have podcast from Design Lab, and Core 77 Design Awards for 2024 that discusses process more in-depth

Questions

1. Engaging with community of practice, and how did you get CoP to participate, and if problem statement co-created with them
   1. Problem statement defined by funders, and health literacy
   2. For selecting partners and knew major players in community with university partners and community members of triangulating greatest impact and reach
2. Fidelity of prototypes used for CoP?
   1. Prototypes were low-fidelity and most important part was storyboards to conceptualize key moments and had idea of wait-room promatora
      1. Outlining visit experience and how people interacted with it
   2. Show piece of paper and flyer that promotes service and prioritizing needs for a visit and talking with covid vaccines and people felt judged and intimidated— needed to come up with set of questions
      1. Who should deliver message, and paper prototypes and make people feel empowered to give feedback
      2. Prototypes feel too high-fidelity, sense that it was done and couldn’t be changed
         1. Balance between sense of what was going on, and preventing intimidation, flexible enough for changes
3. How was pilot success measured, i.e. confidence?
   1. Had excellent evaluation team, and expertise of behavioral science team, and survey instruments
   2. Requirement of compensation to complete surveys and in-depth interviews and inform gains made