Providing Technical Assistance for Community Organizations: The ACCESS-MSU Partnership for Arab Health

Representatives of the ACCESS Community Health and Research Center.

Men, women, and children who move to a different country often experience transitions that affect their socio-economic status, and subsequently, their health. The Detroit metropolitan area has one of the largest Arab populations in the United States, and MSU is a partner in addressing health issues that impact their well-being.

ACCESS (formerly known as the Arab Community Center for Economic and Social Services), based in Dearborn, Michigan, works to understand and address health status, needs, and disparities among Michigan's Arab populations.

What began as a conversation between Adnan Hammad, the former senior director of the ACCESS Community Health and Research Center, and Hiram E. Fitzgerald, MSU associate provost for University Outreach and Engagement and University Distinguished Professor in Psychology, evolved into a collaboration that is now in its fifth year.

The partnership emphasizes the development of co-creative solutions for issues of concern to ACCESS and the communities it serves. MSU Outreach and Engagement links MSU faculty and academic staff with ACCESS professional staff to promote evidence-based practices in health care, research, training, national/international conferences, and information dissemination.

ACCESS is the largest and most comprehensive Arab community-based health and mental health center in North America. The organization provides a wide range of social, economic, health, and educational services to a diverse population. The research programs continually acquire grants to better understand and improve health for Arab Americans. Integrative prevention strategies and lifestyle changes result in the growth of evidence-based practices in Arab communities and collection of data pertaining to Arab health in Michigan.

ACCESS aims to address the gap in knowledge by stimulating research, documenting outcomes, and promoting collaboration with researchers and scientists interested in the health of Arab communities. ACCESS Community Health and Research Center, the International Conference on Health Issues in Arab Communities, and ACCESS Health Journal are closely coordinated to further the understanding of the status and health needs of Arab communities.

Pilot Study

Health screening at the ACCESS Community Health Research Center.

One long-term objective of the ACCESS-MSU partnership is to establish a statewide survey assessing the health of Arab/Chaldean Americans in Michigan.

"There is not a systematic analysis of data collected by federal and state agencies to understand the health or long-term impacts of health in Arab American communities, because the federal government does not recognize Arabs in the U.S. as a minority. That is why performing an independent survey has proven so valuable," said Hassan Jaber, ACCESS executive director.

Miles McNall, director of MSU's Community Evaluation and Research Collaborative, worked in partnership with MSU researchers to develop a survey instrument, a sampling strategy, and an interview procedure that could be implemented by members of the ACCESS staff.

The 2011 pilot study tested the feasibility and acceptability of a modified Behavioral Risk Factor Survey (BRFS) instrument, a sampling strategy, and face-to-face interviewing procedures among a small convenience sample of Arab/Chaldean Americans in Michigan.

The ACCESS-MSU researchers added questions to the BRFS related to ethnic identity, immigrant/nativity status, language and literacy, dietary acculturation, access to healthcare, substance use, and income. The modified survey instrument was then translated into Arabic.

The pilot study determined that face-to-face interviews were a more effective method because of Arab/Chaldean Americans' reticence with strangers over the telephone.

The team trained interviewers in techniques and research ethics. After interviews there were regular debriefing meetings with the research team to identify and correct any problems encountered with the survey instrument, recruitment procedures, or survey administration.

"This involves a deliberate and collaborative process to discuss what works and what doesn't. We co-create effective strategies that can move the work forward. Dialogue and communication are powerful assets when designing a project that is built on community involvement," said McNall.

Interviewers recruited study participants by identifying people through their local Arab/Chaldean communities, or by contacting local leaders via mosques and community centers to obtain a sample that reflected the full diversity of Arab/Chaldean communities in Southeast Michigan.

The strategy proved effective, garnering responses from all but one of the individuals asked to complete the survey, along with respondents' willingness to answer sensitive questions pertaining to their health and wellness practices, such as alcohol/tobacco/substance use, mental illness, and child/adult abuse.

2013 Arab Behavioral Risk Factor Survey

Hammad and McNall met with Sheryl Weir, Health Disparities Reduction and Minority Health Section (HDRMHS) manager at the Michigan Department of Health and Human Services, to discuss the pilot study methodology and results.

HDRMHS provides and improves the availability of health related data for racial and ethnic minorities in Michigan. The Michigan Department of Health and Human Services (MDHHS) Chronic Disease Epidemiology Section, in collaboration with the Population Health Surveillance Branch of the Centers for Disease Control and Prevention and MSU Institute for Public Policy and Social Research (IPPSR), conducts an annual Michigan Behavioral Risk Factor Survey (MiBRFS). The MiBRFS collects statewide prevalence data for the Michigan adult population related to risk factors and conditions associated with many of the leading causes of morbidity and mortality.

The MiBRFS uses a statewide sampling process and, as a result, some of the smaller racial/ethnic populations within the state (e.g., Arab/ Chaldean adults) are not reached in large enough numbers to result in reliable health estimates for these populations. To address this, the 2013 Michigan Arab Behavioral Risk Factor Survey (ABRFS) was developed and implemented.

HDRMHS secured funding for the 2013 ABRFS, the first statewide survey to focus on adults of Arab descent in Michigan and provide state-specific, population-based estimates for various health behaviors, medical conditions, and preventive health care practices.

McNall and the team used preliminary data from the MiBRFS to modify and add questions that addressed country origins, English literacy, length of time in the U.S., and other questions tailored to Arab/ Chaldean culture.

Unlike the pilot study, the scope of the project required phone, rather than face-to-face, interviews so that costs and time constraints could be kept within budget.

"It was definitely a collaborative effort," said Weir. "It provided a forum where we were able to talk about the importance of understanding cultural aspects of the communities and the importance of cultural context in interpreting the data."

ACCESS was a community conduit, sending out notices informing local community members about the survey and requesting participation. Wayne State University professor Kendra Schwartz contributed a surname database of over 9,000 unique Arab surnames she developed that was critical to making the survey efficient and affordable. The MSU IPPSR Office for Survey Research collected the data.

Data from the 2013 survey provide important information needed to help develop effective and culturally appropriate programs and services for Michigan residents of Arab descent. Health Risk Behaviors among Arab Adults within the State of Michigan, 2013 is the full report; it was introduced by the Michigan Department of Health and Human Services in June 2015. A summary report, Health Status of Arab Adults in Michigan, was created to accompany the full report. Both documents are available online at michigan.gov/minorityhealth.

"The information is highly useful to community agencies and health centers, medical providers, and public health agencies," said Weir. "We foresee other states taking a closer look at how we did things. To my knowledge, we are the first state to conduct a stand-alone survey of Arab/ Chaldean populations."

During the Seventh International Conference on Health Issues in Arab Communities, held in Oman in March 2015, MSU researchers McNall, Harry Perlstadt, and Stephen Gasteyer, along with Rosina Hassoun from Saginaw Valley State University, presented at a session on Arab American and Chaldean health in Michigan.

McNall discussed conducting the statewide Arab/Chaldean BRFS survey and addressed methods and challenges associated with developing a cost-effective approach to surveying this population. Perlstadt presented on health care coverage and access to health care, Hassoun presented on acculturation and health, and Gasteyer presented on health behaviors.

Looking Forward

Weir is currently reassembling a working group to look ahead at a second statewide survey in 2016. She envisions a smaller, more focused team, with additional community representation.

"There will be interesting discussions around planning, data analysis, whether or not we add or change content. UOE and IPPSR will continue participating, with McNall serving as the chief collaborator representing MSU. They are key members of the team," said Weir. "We plan to look at lessons learned and move forward in a knowledgeable way."

Dr. Hammad has since transitioned from the ACCESS Community Health and Research Center (CHRC) and is now the executive director of the National Arab American Medical Association. Mona Makki became the CHRC director and, as MSU's collaboration with ACCESS continues, she is in conversation with McNall and Shaheen to discuss the next phase of collaborative efforts.

"The data collected and disseminated through this partnership promote public awareness about the health status, as well as the problem areas and disparities, of Michigan's Arab and Chaldean citizens. We value MSU's involvement and are already hard at work determining priorities for the 2016 survey with the help of our dedicated partners," said Makki.

"We are in the process of discussing other projects and prioritizing future goals. Research, scientific data, and collaborative efforts have really turned this into an effective partnership," said McNall.

Sources and Further Reading

• ACCESS website: accesscommunity.org
• Arab American Institute Foundation. (n.d.). Quick facts about Arab Americans. Retrieved from http://b.3cdn.net/aai/fcc68db3efdd45f613_vim6ii3a7.pdf
• Michigan Department of Health and Human Services. (2015, June). Health risk behaviors among Arab adults within the State of Michigan: 2013 Arab Behavioral Risk Factor Survey. Retrieved from http://www.michigan.gov/documents/mdch/Health_Risk_Behavior_Full_Arab_491350_7.pdf
• Michigan Department of Health and Human Services. (2015, June 15). New report focused on Michigan adults of Arab descent aims to reduce health disparities [news release]. Retrieved from http://www.michigan.gov/som/0,4669,7-192-29942_34762-357219--,00.html