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Partnering with Marginalized Populations to Improve Health and Healthcare
Partnering with Marginalized Populations to Improve Health and Healthcare


Research indicates that significant healthcare disparities exist amongst certain populations. The reasons for the inequities are numerous and varied. In the School of Social Work’s Regional Research Institute for Human Services (RRI), Dr. Christina Nicolaidis focuses much of her work on improving health and healthcare for marginalized populations. She does so by conducting community-engaged research projects that address specific health and healthcare issues in culturally tailored ways.

Dr. Nicolaidis joined PSU in 2012 as Professor and Senior Scholar in Social Determinants of Health. She leads the Social Determinants of Health Initiative (SDHI). She also holds an appointment as Adjunct Associate Professor of Medicine and Public Health at Oregon Health and Science University (OHSU) where she teaches and practices Internal Medicine.

Along with colleagues at PSU and other universities and with partners from populations traditionally not-well served by the healthcare system, Dr. Nicolaidis has led and co-led programs and studies funded by the Center for Disease Control (CDC), the National Institute of Mental Health (NIHM), the National Institutes of Health (NIH), the Robert Wood Johnson Foundation, and the Oregon Clinical and Translational Research Institute (OCTRI) among others. Using methods of community-based participatory research (CBPR), Dr. Nicolaidis has collaborated with members of the African-American and Latina communities as well as with adults on the autism spectrum, people with developmental disabilities, and people with chronic pain or mental illness to develop, implement, and evaluate community-based interventions to improve health and healthcare.

“I think it is important for communities and academics to form partnerships to address these issues,” said Dr. Nicolaidis. “Community members help us determine what projects are important to them while academics assure the research is scientifically sound and advancing knowledge in some way.”

The Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) program is one such partnership. According to Dr. Nicolaidis, who serves as the program’s co-director, AASPIRE is a community/academic partnership comprised of academic researchers, adults on the autism spectrum, family members, disability service providers, and healthcare providers whose mission is to actively include individuals on the autism spectrum in research on autism. Since 2006 the program has undertaken several projects, each of which brought adults on the autism spectrum together with academic researchers to address certain healthcare needs and disparities within the community. The AASPIRE research partnership has produced numerous publications and presentations and several projects including one to develop an interactive website and toolkit to help improve healthcare access and quality for people on the autism spectrum. Information about this and other projects such as Partnering with People with Developmental Disabilities to Address Violence and Health, a project lead by fellow PSU researchers Drs. Mary Oschwald and Laurie Powers, is available at the AASPIRE website. 

“As you can imagine,” said Nicolaidis, “individuals on the autism spectrum and those with developmental disabilities face significant challenges when it comes to healthcare. So much of obtaining proper care is reliant on communication, personal relationships, and executive functions that are very much a part of the diagnostic criteria of autism itself. AASPIRE aims to work with adults on the autism spectrum to improve primary care services.”

As Dr. Nicolaidis notes, one of the key benefits to the CBPR research methodology is that it provides for culturally tailored interventions to address problems faced by marginalized populations. The recently completed Interconnections Project is another example of this kind of practice. A partnership between OHSU, PSU, and the Bradley-Angle House developed, implemented, and evaluated a community-based depression care program for African-American and African women who were victims of Intimate Partner Violence (IPV). The study showed that such an intervention may be a promising tool for addressing depression in a population less likely to pursue traditional methods of management such as mental health services and antidepressants. A similar study was conducted with a Latina population.

“In this project,” said Dr. Nicolaidis, “the interventions we developed were based out of grassroots community organizations. We used a chronic care model for addressing depression, but rather than having it begin in the mental healthcare system, community members who had themselves experienced violence and depression act as coaches and advocates to help women develop self-management skills and refer them into the healthcare system.”

Working with communities to target, study, and address specific healthcare disparities with culturally attentive interventions no doubt informs Dr. Nicolaidis’s broader work as the leader of the Social Determinants of Health Initiative (SDHI) at PSU.

According to the World Health Organization SDH are: 

[T]he complex, integrated, and overlapping social structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world.

The SDHI was launched in 2012 through the cooperative efforts of the Schools of Social Work and Community Health, the Department of Sociology, and with the support of the Provost and Research & Strategic Partnerships. With Dr. Nicolaidis at the helm, the initiative supports and conducts community-engaged, interdisciplinary research, education, and action to promote health equity with the goal of improving community health. The initiative brings together faculty from disciplines across the university, the community, and OHSU to identify, understand, and address social determinants of health.

“The focus of the Initiative,” said Nicolaidis, “is on issues both upstream and downstream pertaining to health. So from issues like poverty and racism all the way down to the availability of health services—the whole continuum of factors that have an effect on people’s health. We’re working with communities and leveraging resources to try to better address health disparities. We’re not going to eliminate racism, but naming it and incorporating culturally acceptable ways of overcoming its adverse effects on healthcare: that is how we can come to solutions.”

Authored by Shaun McGillis
Posted December 11, 2013