Sharkey Presentation Perspectives from CHWs as researchers in a nutrition participatory observation project in South Texas colonias Julie St. John, MA, MPH Joseph R. Sharkey, PhD Barbara F. Sharf, PhD Thelma Aguillon, CHW

Sharkey Presentation Hidalgo County, TX

Socio-demographics Hidalgo County: Population: 655,202 90% Hispanic 13.4% unemployment rate 36% below FPL 50% high school graduate or higher 83% speak a language other than English at home 60% uninsured > 20% live in colonias In Hidalgo County, 88% are Hispanic; 36% live below 100% FPL; 60% are uninsured; 13.4% are unemployed; 50% have a high school diploma or higher; and the per capita income is less than half the state and national averages ($13,344 a year).

Colonias Definition of Colonias: unregulated residential areas lacking basic services (water, electricity, roads, etc.) and infrastructure Colonias are recently formed neighborhoods. Often they are ½ acre plots with low financing—former farm land, etc. Residents will often start out with trailer homes or RVs, or small shacks made of plywood and particle board. They often lack basic services such as water, electricity, roads, mail system, etc. For example, One neighbor might have electricity and they connect to other homes with extension cords. Often they will have one water facet outside the home as their only source of water supply. For cooking, they often cook outside or have propane tanks. If they have a stove, they are gas powered.

Colonias Low-income housing areas Key characteristics: Sharkey Presentation Colonias Low-income housing areas Key characteristics: Low cost (minimal down & minimal monthly payments) Self-built dwellings Physical conditions improve over time Low-density settlements (ETJ)

Colonias Mixture of housing types Substandard “neighborhoods” Sharkey Presentation Colonias Substandard “neighborhoods” Lack basic services Inadequate infrastructure (roads/drainage/electricity/water) Mixture of housing types Recycled materials Trailers Self-built

Houses in a San Carlos colonia Canal in back of house shown above Colonias Houses in a San Carlos colonia Canal in back of house shown above

Colonia Resident Characteristics Sharkey Presentation Colonia Resident Characteristics High rates of diabetes and obesity Persistent poverty Sub-standard housing Low educational levels High unemployment rates

Participatory Observation Project (POP) Sharkey Presentation Purpose: Test a complex form of participant observations focusing on actual food-related behaviors of family members as observed by researchers in the families’ colonia homes Underlying goal: Demonstrate the effectiveness of using CHWs to conduct research in a community setting.

Sharkey Presentation POP Teams Bilingual Promotora (community health worker) & formally trained researcher Team members involved in developing protocol Trained in ethnographic methodologies

Training Developed home observation guide Ethnography workshops on conducting participant observations and writing detailed field notes

Promotora Role Shift Traditional & Emerging roles/competencies: Health promotion Education Outreach community organizing Facilitation Problem solving/solution finding Program planning/implementation POP role: Conduct research

POP Eight different families for one weekend day and two half-days Families recruited by promotoras from two clusters of colonias Eight different families for one weekend day and two half-days Document feasibility of PO in colonia households

Gift Baskets

Home Observations

Debrief Identified issues: Dietary decision-making patterns Cultural practices within the geographic & cultural setting of the colonias Meanings ascribed to these patterns by family members.

POP Team

Contact Information Center for Community Health Development School of Rural Public Health, Texas A&M Health Science Center 2101 South McColl Rd. McAllen, Texas 78503 (956) 668-6337, jastjohn@srph.tamhsc.edu http://www.cchd.us/ Acknowledgement: The Center for Community Health Development participated in this pilot project as part of the Integrated Health Outreach Systems Project (Project # 053651) funded by the Robert Wood Johnson Foundation. The Center for Community Health Development is a member of the Prevention Research Centers Program, supported by the Centers for Disease Control and Prevention cooperative agreement number 5U48 DP000045.