By Dr. Mohamed Hamdy, Unit Coordinator, Colorado Muslim Society Medical Reserve Corps (MRC)

With NACCHO’s support, the Colorado Muslim Society MRC was able to conduct a comprehensive survey to identify health disparities within their community. The research has uncovered demographics about the community that can be used to address medical and emergency preparedness needs within the community. The group also received a 2013 NACCHO MRC Challenge Award to further support this work. Dr. Hamdy provided a summary of the project below.

The Colorado Muslim Society MRC Unit was established in September 2011, with support from the Capacity Building Award 2011-2012 from NACCHO and a supplemental award from the Colorado Department of Public Health and Environment. Our unit functions to organize and utilize health professionals and other volunteers to promote community health and a coordinated response to community emergencies.

NACCHO’s annual Capacity Building Award helps to grow a unit’s capacity by providing funding that can be used for projects, training, or other activities that address communities’ local needs and interests in emergency response and/or public health activities. In 2012, NACCHO offered a Competitive Capacity Building Award, and applicants for this award were challenged to think creatively in addressing their community needs through creative partnerships, tools, resources, or new program initiatives. Our project for the Competitive Award fell under the “Eliminating Health Disparities” category, and focused on identifying barriers to personal and family health access among the Colorado Muslim community. Our goals were to conduct a medical needs assessment study and to assist the community in developing awareness, training, and service programs to keep its members healthy and safe in cases of emergencies. Because of time and funding constraints, the project was conducted as a pilot study using the community of the Colorado Muslim Society as its domain.

The pilot project used a carefully designed English language survey to gather information from a random sample of the Colorado Muslim Society’s community. The survey consisted of 63 multiple choice questions covering areas such as demographics, personal health issues (i.e., disabilities, chronic illnesses, and hospitalizations), use of preventive/prenatal care, trusted sources of health information, insurance coverage, and any inability/difficulty accessing needed health care in the prior year.

A random sample was obtained through selecting and training translators/interpreters from the community’s diverse ethnicities, each to contact some of his/her community members, assist them in answering the questions, and collect completed surveys. Emphasis was placed on collecting information from men and women equally. This approach was used in place of translating the survey into the many languages of the various community ethnicities, which would have been complicated, time consuming, and expensive. Moreover, it allowed information gathering from less-educated community members. Three hundred twenty-five surveys were distributed and 203 were completed and returned for a rate of 62.46 percent. Although our approach proved to be successful, finding appropriate surveyors with competency in English/native languages that had time, willingness to volunteer, and accepted the responsibility for such a task was a tedious process.

Because of the length and complexity of the survey questions, only selective data analysis of the gathered information was presented in the report components. The survey data analysis was achieved by using the online system Survey Monkey. Its use identified some bugs which were not recognized during the survey design. Some members did not want to answer, and others misunderstood the questions. To resolve this problem during the interpretation of the results, sub-tables were constructed manually and/or written explanations were provided.

Our proposal stressed that the Colorado Muslim Society community is large and quite diverse in citizenship, ethnicity, country of origin, languages, education levels, medical knowledge, income, family size, cultural orientation, and health insurance. Since such factors have direct relationship and impact on assessing the community’s medical needs, they were considered a necessary part of the study. Thus, the survey’s first 12 questions were designed to gather demographic information. From this broad perspective, we found there were numerous access barriers related to healthcare, including education, language/communication, financial constraints, religious beliefs, and customs, as well as the limitations of insurance coverage.

Some of our specific findings include:

• The Colorado Muslim Society community consists of at least 34 different nationalities, speaking over 23 languages.
• Over 94 percent are recent (past 5-7 years) immigrants, refugees, or asylum-seekers.
• Most respondents (70.7%) fall in the low income or poverty category. Among low income respondents, 47.6 percent are either not qualified for any job or can only be employed in menial work.
• The majority of the respondents are employed, but do not earn high incomes.
• Family size of most respondents is small to medium, ranging between one to six members. A few families are large to very large, ranging from seven to 19 members. Family size has major impact on healthcare as well as insurance rate considerations.
• As education level increased, health insurance coverage increased. Interestingly, the number of uneducated respondents who have health insurance is high, probably due to Medicaid coverage.
• Respondents from all language groups stated that language barriers create problems in accessing, understanding, and receiving adequate doctor recommendations and health related information.
• Most women respondents maintained that their preference to be attended by the female providers often delayed or discouraged them from receiving medical services; most prefer same gender providers, based on Islamic traditions of modesty and privacy.

From the study data, our immediate objectives are to maximize mutual communication and understanding between the Colorado Muslim Society community and healthcare providers, and to increase the supply, accessibility, and culturally sensitive delivery of services for Colorado Muslim Society members. We are pursuing nine specific responses to the needs identified, including developing and introducing educational and orientation programs to enhance community members’ health literacy and capacity to navigate the healthcare system.

The study was labor intensive, requiring an extensive amount of time and the use of a large number of volunteers for its implementation. It mainly relied on surveying Colorado Muslim Society community members who attend and use its facilities. Therefore, the data represent the Colorado Muslim Society community, but do not represent a full cross-section of the Colorado Muslim community. Further studies in collaboration with other Muslim communities across the State are needed to address current gaps in our knowledge about how they utilize healthcare services and the challenges they face in healthcare settings, while also exploring potential resources, policies, and practices that can enhance cultural competence and accommodation.

The process for conducting such studies already began, as our MRC unit’s hard work and the successful completion of the Pilot Project were recently rewarded by receiving the 2013 NACCHO Challenge Award, an evolution of the 2012 Competitive Capacity Building Award, to complete these studies. Many thanks go to NACCHO for the Competitive Award, without which the study would not have been possible, and for continued support of our MRC unit’s efforts to further the research for assessing the Colorado Muslim Community’s medical and emergency preparedness needs.