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Increasing Access to Vaccinations at the Mexican Consulate

Nelly Salgado de Snyder, Roxana Pineda, Brenda Perez, Alondra Morales, Dania Diaz

By Claire Hutkins Seda, Writer, Migrant Clinicians Network and Managing Editor, Streamline

“They say, ‘I need more information.’ And I say, ‘I can give you more information!’” laughed Roxana Pineda, Migrant Clinicians Network’s Ventanilla de Salud Coordinator and Health Network Associate. The information she’s giving is about vaccinations — but she does more than just provide information. At the Mexican Consulate in Austin, Pineda provides health outreach and organizes weekly health fairs to increase health access for Austin-area Latinos through MCN’s partnership with Ventanilla de Salud, a program of the Institute for Mexicans Abroad to help Mexicans and their families residing in the US increase access to health services. Under a project launched in the spring of 2019, she and her MCN team began to work directly with Consulate visitors who may not have easy access to immunizations to first get them information and resources about vaccines, and then link them up with a City of Austin Public Health team at a Consulate health fair where the vaccine is available for free. And it is working.

“In the last few months, the work of Roxana has been incredible. Immunization is important,” emphasized Nelly Salgado de Snyder, MA, DSW, a visiting scholar and researcher from the Instituto Nacional de Salud Pública de Mexico. Salgado de Snyder stepped into the vaccination project that Pineda and MCN’s Deliana Garcia, Director of International Projects and Emerging Issues, had developed for three undergraduate interns. The project aimed to engage male visitors to the Mexican Consulate to better understand why Latino men have lower vaccination rates than women, and to follow up immediately with any resources or information to enable them to get vaccinated if they choose. Salgado de Snyder, leaning on decades of research, evaluated the initial questionnaire and methodology.

“I helped [the interns] understand what methodology is. I gave them a class on research methods: how to go about collecting information, the importance of constructing a survey properly, what the procedures are,” she recalled. “They were very receptive.” Salgado de Snyder followed up that training with more on how to develop unambiguous and concise research questions. Then, the interns applied their new knowledge to the vaccination project, and developed a questionnaire to pilot. After a short pilot period and some minor resulting adjustments, the interns, supported by Pineda and Salgado de Snyder, began to engage with male visitors to the Consulate.

“People at the consulate are there to get a passport or a birth certificate; they’re just waiting… but the men were reluctant,” she recalled. Many would avoid looking at the young researcher-interns, hoping they wouldn’t approach. “But we would introduce ourselves, tell them we’re conducting this very brief survey, and request verbal consent,” pushing ahead despite verbal cues, Salgado de Snyder said. Anecdotally, the interns found that women were far more willing to be approached, even asking the researchers why they weren’t being included. Many reluctant men were spurred on by their wives or female partners to participate. “What was interesting was that when men saw that other men were responding to the questionnaire, they’d be more willing to participate,” Salgado de Snyder also noticed. “Men we had approached and said no, when we returned 10 or 15 minutes later, after they saw other men responding and that there was nothing to worry about, they’d say, ‘okay, I’ll respond.’”

The results of their work were evident within a few weeks. Every Friday, Pineda organizes a community health fair in conjunction with numerous Austin health agencies that provide direct services, including the provision of vaccinations for free to anyone who needs them. After the research participants answered the questions, Pineda and the interns followed up with more information and resources, including an invitation to a Friday health fair, for the men and their families. Following the start of the research project, Pineda saw an increase in the provision of vaccinations at the Friday health fairs. She credits the outreach provided while research was conducted as one factor, in addition to increased presence on social media and a growth in partnerships.

“Many [of the men we interviewed] thought that vaccines were medication, so they have this misunderstanding that if you don’t get sick, you don’t need them. That’s misinformation,” Salgado de Snyder said. “We explained to them, no, it’s to prevent illness. Very often, men are the only breadwinners in the family, and they work in very high risk jobs, so if they get sick, the consequences for the family will be terrible.”

“We try to provide examples of why they are important, for example, tetanus. For men, it’s really important,” Pineda added. She, like Salgado de Snyder, emphasizes it’s not just for one’s health — it’s a money-saver. Even for those not employed in jobs that have high injury rates, men still engage in risky behavior in the home during basic home maintenance, Pineda said. “If you get a cut or injury, and go to the hospital, they can charge you, just for the [tetanus] vaccine, more than $100. If they get the vaccine for free, then they can tell the nurse, ‘I’ve already had this vaccine.’ With everyday examples like this, I make the economic case,” to get the vaccine.

Salgado de Snyder is now evaluating the data they collected and, along with Pineda and the undergraduate interns, plans to publish their findings. “It’s a win-win,” Salgado de Snyder said. “We really need to strengthen this area of research. The interns got to learn a little more about conducting research, and we can benefit from the information we collected.”

          

Resources

Pineda and her team bring information to visitors to the Mexican Consulate about the benefits of vaccinations. She recommends Centers for Disease Control and Prevention pages for factsheets and information, including: 

CDC’s Vaccination Resources For Partners includes waiting room videos, posters, fact sheets, and more: https://www.cdc.gov/vaccines/hcp/adults/for-partners/ 

CDC’s Adult Vaccination Resources For Educating Your Adult Patients has more specific resources for specialized groups, like Spanish speakers and adults with chronic conditions.
It also has disease-specific resources: 
https://www.cdc.gov/vaccines/hcp/adults/for-patients/index.html 

CDC’s Adult Vaccination Resources: Educating Adult Patients: Vaccination Resources has colorful flyers, posters, and print ads: https://www.cdc.gov/vaccines/hcp/adults/for-patients/adults-all.html
  


Health Network and PRAPARE
In 2016, just as PRAPARE was set to launch, Migrant Clinicians Network was beginning to develop its new database to better serve patients enrolled in Health Network, MCN’s bridge case management program. Over the course of the following year, MCN configured the new database to allow for the integration of PRAPARE data, in which one health center’s PRAPARE data can be transferred to the next health center, as a mobile patient moves.
“When we started thinking about that data and [Health Network] case management work, so much of case management isn’t just ‘are you taking your medication every day?’ It’s more about, ‘How can I help you access care and manage your health in general?’” explained Anna Gard, RN, who assisted MCN in the development of the new database. “One piece of this is: ‘Let me help you find a health center.’ But the larger pieces around effective case management are, ‘How are you going to get there? Is there public transportation? How are you going to pick up your medications if you live in a hostile community and you’re afraid of leaving the house?’ PRAPARE gives a structured format to capture [these] data, in a form that’s been tested and validated.”
As more health centers provide case management and chronic care management to address the social determinants of health, Gard noted, integration of the PRAPARE data with Health Network, a virtual case management, seemed to make sense. Now, the Health Network team is working to fit PRAPARE into their own workflow.
Saul Delgado, Health Network Data Specialist, who has been integral in building and launching Health Network’s new case management system, notes that asking such personal questions over the phone, when a patient doesn’t have transferrable PRAPARE data from a previous health center, can be challenging. “When we call, the patient doesn’t know you. They’re very scared to answer these kinds of personal questions, whereas when you go the clinic, you at least see the nurse or case worker face-to-face,” he explained. But he recognizes the utility of the data, and has developed the PRAPARE data screens within the database to be easily accessed from the main patient information screen. With drop-down menus, Health Network Associates can populate the information they hear from patients, like how many people live with them in their household, or if they’re worried about losing their home. The information, either attained from a previous health center or inputted by a Health Network Associate, will be transferred when the mobile patient gets to his or her next destination, just as the basic medical records do.
“Health centers are doing more to integrate social and behavioral determinants of health, and we’re recognizing that all of those things have to be integrated with care management. So we’re on the forefront,” Gard concluded.

MCN Streamline Fall 2019

Read this article in the Winter 2020 issue of Streamline here!

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