Partnerships Insights: Addressing Health Disparities Through Community-Based Approaches


Dr. Nadia Islam

A few weeks ago, in honor of Asian and Pacific Islander Heritage Month, we interviewed Dr. Nadia Islam of the DREAM Project to highlight the project's work with South Asian communities in New York City.

Dr. Nadia Islam is a medical sociologist and an associate professor in the Department of Population Health at NYU Langone Health. Her research focuses on developing culturally relevant community–clinical linkage models to reduce cardiovascular disease and diabetes disparities in disadvantaged communities. She leads, as principal investigator, several National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC)-funded initiatives evaluating the impact of community health worker intervention on chronic disease management and prevention in diverse populations.

Can you tell us about the DREAM Project and your role in this initiative?

Within the Department of Population Health at NYU School of Medicine, we have a Section for Health Equity. As part of this section, we conduct health disparities research to really understand what types of health issues are affecting immigrant and minority communities in New York City and what types of clinical programs and community programs we can develop to try to improve health outcomes.

DREAM stands for Diabetes Research, Education, and Action for Minorities and the DREAM Project is one of the projects that fall under the Section for Health Equity and is based in a larger center called the Center for the Study of Asian American Health (CSAAH) at the NYU Langone Medical Center. It's actually the only center funded by the NIH that focuses on Asian American health disparities. 

The goal of the DREAM Project is to develop, implement, and test a Community Health Worker (CHW) Program to improve diabetes control and diabetes-related health complications in the Bangladeshi community in New York City. The project has three specific aims:

  • To utilize the methods of community-based participatory research (CBPR) to expand upon an existing collaboration between academic institutions, health providers, and community-based organizations to develop and implement a CHW program for diabetic Bangladeshi Americans.
  • To examine trends in risk factors and patient outcomes among Bangladeshi Americans diagnosed with diabetes in the New York City public hospital system.
  • To develop, implement, and assess the efficacy of a CHW intervention to improve diabetes management and access to care among the Bangladeshi American community.

At the CSAAH, I serve as the Director of the Cardiovascular Disease and Diabetes Research Track and I’m also the Principal Investigator and Director of the DREAM Project.

What drove the CSAAH at the NYU Langone Medical Center to create the DREAM Project? Specifically, what was the inspiration for developing a program aimed at addressing diabetes in the Bangladeshi community?

Through the DREAM Project, we've been testing models to improve diabetes prevention and diabetes management among South Asian populations. The project came about because, in the South Asian community, we know there are significant disparities in diabetes and cardiovascular disease risk. Compared to other Asian American groups and other racial and ethnic minority groups, South Asians have higher rates of diabetes and tend to develop diabetes at a lower body mass index than other groups. Many South Asians in New York City are limited English proficient, have barriers to care, or have other social and cultural barriers that may impact their ability to manage diabetes effectively. 

As a way to improve diabetes prevention and diabetes management, we are testing a Community Health Worker (CHW) program. The CHWs are lay community members, trusted community leaders, individuals from the community who are easily recognized, and can help facilitate connections to resources. They provide health coaching and resources to improve diabetes prevention and management.

DREAM Project CHWs

What kind of impact has the DREAM Project seen so far? And what inspired the Dream Project to partner with Healthify?

The DREAM Project has gone through many iterations. It was first launched in 2007, and since then, with the Affordable Care Act and the movement to value-based care, there has been more interest in models that link communities and healthcare systems. CHWs are ideally poised to do that, and there are opportunities for us to sustain that work through new payment models. Some of our work has actually been cited as a model that demonstrates its effectiveness. At the community level, the DREAM Project was one of the first studies in New York City to directly address the health of South Asian communities, and we did it in a community-engaged way. We work closely with community partners and stakeholders to identify problems, develop research questions and solutions, and analyze and disseminate results.

We partnered with Healthify because we noticed that a big piece of the CHW role was to link community members to resources. Although they're working on health coaching specifically around diabetes prevention, our community members are faced with so many other issues, particularly because they're an immigrant population. Many are looking for access to additional resources such as ESL classes, job placement opportunities, or unemployment services. With Healthify, we're trying to test whether having this electronic platform can help to make the CHW's work easier and more efficient. 

We are also working to create a closed-loop referral system among community-based partners. One thing we weren't able to do before was track whether a need was met after a CHW makes a referral. Healthify allows us to do that, and the next phase of our work is to have a closed-loop referral system. 

Has COVID-19 impacted the program? How has the Bangladeshi community in New York City been impacted by the pandemic? How does this change the goals of the program?

Like everybody else, we had to quickly transition our work to remote status. Before COVID-19, our CHWs did all of their engagement with community members in person. Typically, we identify community members at risk for diabetes or pre-diabetes from a network of 20 primary care clinics and then conduct outreach on the phone and invite them to attend group-based health coaching sessions. Now, we've had to transition to remote work, use telehealth strategies, and adapt to a remote environment with a very low-income, limited English proficiency, and low tech population. A question we’re grappling with now is how can we deliver information via phone and text message since not everybody has access to Zoom? 

The backdrop of that is how the pandemic has impacted the South Asian community. There have been a really large number of diagnoses but also death, even just among our study participants. Our CHWs connected to the communities have heard about deaths every day. On top of that, we're working with a community that is concentrated in low-wage, service-sector work, like grocery store workers, taxi drivers, vendors, restaurant workers. So many individuals have been laid off or lost their jobs, have lost health insurance benefits, and are now facing food insecurity. That has changed the nature of our work. For example, we're spending a lot more time coordinating grocery delivery, which is not something that we had to do very much before. 

DREAM Project CHWs

Beyond COVID-19, I think there's going to be a lot of residual fear in the community, especially because there were so many COVID-19-related deaths. We’re realizing that more and more of our work needs to be delivered via telehealth, even when social distancing and stay-at-home orders are lifted.

Our focus now is on how we can deliver all of our content via telehealth and how we can enhance the capacity of our CHWs, as well as our community members' capacity to access services. Our other focus is on continuity of care. Many of our clients were receiving primary care services in offices that have since closed down and are not offering telehealth services. Diabetes patients, in particular, are at-risk. Many patients need their A1C checked on an ongoing basis, and regular medication refills, so we are concerned with making sure they continue to receive those services without disruption. 

To learn more about the DREAM Project and their work with South Asian communities in New York City, visit their website here.

Topics: population health care coordination COVID-19

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