Bridging the Gap: Open Dialogue

When developing my partnership with Lincoln Community Health Center (LCHC) the concept of patient collaboration was identified as an essential foundation. As I continued to construct my hypertension education intervention, I remained grounded in this foundation and sought to gain a deeper sense of the needs of the population.

I began with anticipating likely barriers to access. According to the Durham County Department of Public Health, approximately 4,551 African American or Black families live below the poverty line. These statistics represent a key contributor to decreased healthcare access. As telehealth becomes increasingly popular, especially in a global pandemic, it is important to recognize arising barriers. Health Affairs acknowledges the absence of technology, digital literacy, and reliable internet coverage as major contributors to the digital divide that disproportionately affects individuals living in poverty. These factors have undoubtedly increased the difficulty of developing a successful intervention. Nevertheless, I started my approach with reaching out to my patients via phone. During these conversations, I assessed potential technology-related social determinants. In summary, I gauged that digital literacy and absence of technology were dominant barriers for my patient population. Examples included some individuals having only a cellular device without smart functions, not having computers or similar alternatives, and inadequate knowledge about how to do things such as access internet links. After gaining this insight, my approach shifted to the idea of placing access on two central platforms – the LCHC website and affiliated YouTube page. The thought behind this methodology was to ensure that access was as uncomplicated as possible. The patients would not have to search for and access their links through emails, both platforms were smartphone-friendly, and both platforms were familiar to most if not all of the patients.

As my team and I worked to establish the educational class links, we made the decision to initiate a test-run. In an effort to maintain the foundation of patient collaboration, we invited two individuals deemed “hypertension heroes” to be present for the test-run and provide feedback. Our hypertension heroes are individuals of the Durham and LCHC communities who have participated in previous hypertension-related interventions and now voluntarily act as awareness advocates for their peers. This collaborative experience yielded open dialogue that has been extremely valuable as we continue to craft our intervention.

The first insightful lesson came as one of the heroes detailed his difficulty with joining the meeting. In alignment with the aforementioned barrier of digital literacy, the hero explained that he had trouble accessing the zoom link on his smartphone. He further shared having to walk to his neighbor’s house to get assistance with access. When evaluating this example, I am able to get a stronger grasp on the implications related to this disparity. What if the hero did not have a helpful neighbor? What if he was also disabled and would not leave his house to seek help? What if he simply became too discouraged by the lack of ease in accessing the class so he gave up? This is how social factors are able to so drastically act as health determinants. However, without engaging in dialogue with patients and hearing stories such as the one of this hero, myself and other healthcare providers can not fully understand the daily struggles that patients face.

Additionally, this lack of understanding leads healthcare providers to view patients as “non-compliant” or not being actively involved or interested in their health.

The open dialogue continued after I completed the mock educational presentation. When prompting the heroes for feedback, they mentioned that it was helpful to simply have the information reiterated even if it had been delivered to them in the past. This provokes the idea of continuity of care. As mentioned in my previous posts, many of the patients that LCHC services are uninsured. Due to this barrier, it is likely that many have experienced a lapse in established primary care at some point which can prevent follow up and repetition of education. This further highlights the significance of my intervention and other voluntary partnerships.

Following this mock experience, I am increasingly motivated to start implementation. In the following few weeks, my team and I will establish an educational platform that we hope can be maintained by LCHC professionals and continue to benefit the community.

Unique Whitehurst is from Long Beach, CA. She is a member of the Duke University School of Nursing’s MSN-NP class of 2023 specializing in psychiatry and mental health. Unique is a recent December 2020 graduate of Duke’s ABSN program where she was recognized as an executive board member for DUSON’s Active Minds organization, an inductee of Sigma Theta Tau International Honor Society, and the selected student speaker and exemplar of excellence at the annual Commitment to Excellence Ceremony. Unique is a current member of the American Psychiatric Nurses Association and serves as a graduate student research leader at Duke. Her research interests center around improving health outcomes for minority populations. Her current research efforts involve collaborating with community partners to decrease the burden of hypertension in African American males here in the Durham County area.

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