A new community health project addressing asthma issues in the San Joaquin Valley is underway thanks to a collaboration between UC Merced, UCSF and Camarena Health, supported by a grant from biotechnology giant Genentech’s foundation.
The project “Promotoras and Community Based Education,” headed by Principal Investigator Rosa D. Manzo, Ph.D., is supported by a two-year, nearly $500,000 grant as part of Genentech’s Giving for a More Just Healthcare System initiative. The grants are given to projects that aim to break down systemic barriers facing Black, Latinx, Indigenous and other people of color in healthcare and education.
The project is based on a pilot last summer that paired promotoras, or community-based healthcare workers, with medical students in the UCSF San Joaquin Valley Program in Medical Education (SJV PRIME) program to address diabetes-related health disparities and increase positive outcomes in underserved populations.
Over the next two years, promotoras will be trained to collaborate with medical students to deliver asthma-management education and tips to Valley residents. Fresno, Kern, Madera, Merced, Stanislaus and San Joaquin counties all earned “F” grades in the 2020 State of the Air report issued by the American Lung Association, based on particulate pollution. Nearly 5,000 children and more than 16,000 adults in Merced County alone have asthma.
The idea behind partnering medical students and promotoras is that the community-based workers can help address cultural gaps.
“In last summer’s pilot, we saw that participants were more likely to comply when we took this approach,” Manzo said.
Some of the biggest drivers of health problems include a lack of information, lack of access to doctors and that people often don’t make time to care for their own health.
“Sometimes the last thing on people’s minds is going to a class to learn about their own health,” said Claudia Chavez, community engagement manager for Camarena. “This program offers multiple ways to increase success.”
By delivering culturally sensitive, language-appropriate and engaging material through the promotoras, and with the help offered by the medical students, people have a better chance of improving their health, she said.
Through affiliations with the Translational Research Center in UC Merced’s Health Sciences Research Institute (HSRI), the promotoras are campus partners with access to the library and other services.
SJV PRIME is designed for future physicians from and educated within the Valley who have demonstrated a commitment to providing high-quality, culturally appropriate and accessible medical care to address the region's unique healthcare needs.
There are 36 students in SJV PRIME. The majority are from socioeconomically disadvantaged backgrounds or from populations that are underrepresented in medicine. SJV PRIME students call the Valley home. Including the Class of 2020, SJV PRIME has graduated 39 students. Thirty-four are completing residency or fellowship training and five are practicing physicians in the Valley or in the military.
SJV PRIME student Lemuel Rivera worked with promotoras last summer, and said the pilot went smoothly.
“Camarena selects the promotoras from the communities they work with, so there are already connections and understanding,” he said. “I was really impressed with the way they interacted with the patients and kept tabs on them.”
The program is part of the curriculum for the medical students, but Manzo said the education they get from the promotoras is valuable, too.
“The medical students learn to approach patients from a whole different perspective, and they learn how to work with diverse communities,” she explained.
Rivera wants to take part in the program because of his experience with the pilot.
“It taught me that medicine is about so much more than just diagnosing and prescribing,” he said. “It taught me a way to maximize patients’ healthcare experience and how to work with the community and let me learn from others.”
Ten to 15 UC Merced undergraduates who are considering careers in healthcare will assist with translations, design surveys and analyze data, said Marisela Yepez, HSRI research project manager.
Much of the project will be conducted remotely because of the pandemic, but organizers believe they’ll show the same success they had with the pilot, which was also delivered virtually. The grant will help provide wireless hot-spots and other equipment to facilitate classes. Yueqi Yan, Ph.D., HSRI chief biostatistician, will lead the project evaluation.
The key to success, Yepez said, lies mainly in the promotora-medical student partnership.
“The promotoras said people in the community were more willing to listen and act because the medical students were there with them and were following up with the community members,” she said. “The students were also able to see barriers of everyday life that can get in the way of patients’ adherence to recommendations and better able to understand where the patients are coming from.”
Genentech and the Genentech Foundation seek to support groundbreaking solutions to promote health equity and diversity in the STEM fields from kindergarten to career. Their Health Equity Survey revealed a critical need to help medically disenfranchised patients.
Nearly 380 academic institutions, health systems, nonprofits, patient groups, think tanks and community organizations applied for a share of $16 million. UC Merced is one of 40 chosen.
“UC Merced is honored to be selected. I love this project because it demonstrates the power of partnering researchers, educators and community health advocates to develop innovative approaches to medical education and healthcare in the Valley,” HSRI Director Professor Deborah Wiebe said.