Topic: Maternal/Child Health Intervention among a mobile, immigrant population
a) In Port Town, a moderately large port city on the U.S. East Coast, infant mortality rates and low birthweight are disproportionately high among residents (“Islanders”) who are from a Caribbean Island we will simply call “Island.”
b) As Director of Maternal and Child Health Promotion for the Port Town Public Hospital Foundation – a non-profit consortium of the three public hospitals in the city – you are tasked with developing and implementing a program to reverse this pattern. You have three years.
c) There have been two waves of immigration from Island. The first wave included a larger proportion of middle income and professional people (fleeing civil strife) than the second wave, which included many lower-income rural and urban people attempting to escape the crushing poverty of their home country. At the same time, Island is not far from the mainland U.S. and many Islanders do continue to go back and forth to Island, for family events, weddings, funerals, and other activities, as well as to visit the family members who remain there.
e) Port Town does have a network of community health centers affiliated with the public hospitals, and some years ago — after the first wave of immigration — there was an attempt to staff the clinics with Islanders insofar as possible. Some of these Islanders had even been doctors or medical professionals in Island (and were thus highly respected elites), though in the U.S. they did not have licenses and could not work as doctors. They were hired as health educators, medical assistants, administrative staff, interpreters, and in other capacities.
f) A collaborative study done by Port Town University Public Health School and the hospital consortium revealed several facts/issues. First, prenatal education classes intended to raise awareness and increase the use of prenatal care/healthy mother services (thus lowering infant mortality) faced very spotty attendance. Research showed that mothers sometimes went back to Island one or more times during their pregnancy, but typically returned to the U.S. to give birth. Or, the expectant mothers were in the U.S. living with relatives, but the father or other key family members were still in Island, hampering education/outreach programs that had intended to involve family members as well as the expectant mother. Second, even when they did not travel back-and-forth to Island, second-wave Islanders often said (in focus groups) that they do not like to go to the clinics because the staff — especially the first-wave Islanders — gave them a hard time and reproached them for their personal habits, or because they did not speak English well.
g) Your plan will involve developing the intervention in collaboration with the Port Town Islander Association, an umbrella group made up largely of first-wave Islanders, but with an increasing and vocal second-wave component.
1. Based on the information provided briefly explain how you would design your intervention
2. Which social/behavioral theories do you think would be applicable in this case (name at least two)? For each of them explain why?
3. Are there any new or emerging technologies you might use to address the situation described? List two and their possible use.
4. Since this is a three-year project, what could you do to evaluate the intervention you proposed in Question 1 (include process, impact, outcome)?