Awardees of 2022 Tier 1 pilot research grants report final project outcomes

The Intersection of Food Security and Planetary Health in Senegal, West Africa: A Mixed-Methods Pilot Study

Investigators
Noëlle A. Benzekri, Department of Medicine/Division of Allergy & Infectious Diseases
Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Julianne Meisner, Department of Environmental & Occupational Health Sciences
Cory Morin, Department of Environmental & Occupational Health Sciences
Lauren Masey, Development in Gardening
Jacques Sambou, District Sanitaire de Ziguinchor, Senegal
Moussa Seydi, Services des Maladies Infectieuses, Hôpital Fann, Senegal
Geoff Gottlieb, Department of Medicine/Division of Allergy & Infectious Diseases
Vickie Ramirez, Department of Environmental & Occupational Health Sciences

Project summary
We conducted a mixed methods study, grounded in the principles of community based partcipatory research, to explore community perceptions of environmental change, to understand the process by which environmental change impacts food security, and to validate community knowledge in the Casamance region of Senegal.

Focus group discussions and in-depth interviews with community members, stakeholders, and key informants were conducted to explore perceptions, beliefs, and experiences regarding climate change and changes in the environment, and to understand the process by which these changes impact food security and influence behaviors. The themes that emerged from the exploratory focus group discussions and in-depth interviews contributed to the development of a community informed interview guide. This interview guide was subsequently used to conduct semi- structured interviews with community members in the Basse-Casamance region. The Household Food Insecurity Access Scale (HFIAS) was used to measure food insecurity. The 9-item HFIAS was developed by the USAID Food and Nutrition Technical Assistance project to assess household food insecurity across different cultural contexts. It provides a categorical indicator of food insecurity status on a scale of 1–4, with 1 being not food insecure, 2 being mildly food insecure, 3 being moderately food insecure, and 4 being severely food insecure. Interview participants were selected using purposeful sampling. All participants provided informed consent. Interviews were conducted in the participant’s preferred language, which was predominantly Diola, Wolof, or French. Qualitative analysis was guided by the grounded theory approach using inductive coding and the constant comparative method.

Strategies proposed by community members and participants to strengthen resilience in the face of increasing food insecurity and environmental change included, campaigns to halt deforestation and increase awareness of activities that harm the environment, providing training and concrete skills in sustainable agriculture, implementing reforestation initiatives, and reinforcing and expanding the mandate of government environmental agencies (such as the Ministère de l’Environnement et du Développement Durable and l’Agence des Eaux, Forêts, Chasse et de la Conservation des Sols) to enhance environmental protection and regulation. Next steps will include the presentation and publication of study results and application for future funding. We also plan to incorporate high-resolution aerial images and meteorological and land use data sets to triangulate data obtained from community interviews and to validate community perceptions of ecosystem change. We are currently planning two manuscripts based on the results of this study and we anticipate two research proposals based on the results of this study. The first proposal will focus on the health-associated and cultural impacts of deforestation in communities bordering the forest in the Basse-Casamance region. The second proposal will be prepared in collaboration with our longtime partners at DIG (Development in Gardening), and will focus on the implementation and evaluation of a nutrition-sensitive, environmentally sustainable agriculture program in the Casamance region of Senegal.

Addressing Burnout Among QTBIPOC (Queer, Trans, Black, Indigenous, People of Color) Therapists Working in Community-Based Organizations through Cultivating Wellness and Sustainability

Investigators
Justin Lerner, School of Social Work
Agnes Kwong, Interconnections Healing Center
Yungee O’Connell, MEND Seattle Therapy Services
Tanya Ranchigoda, MEND Seattle Therapy Services, School of Social Work

Project summary
The aims of this Tier 1 proposal were: 1) to identify current levels of burnout among QTBIPOC therapists working in two QTBIPOC-led and QTBIPOC-centered community agencies and 2) to understand how burnout is affecting wellness levels of QTBIPOC therapists as they enter a third year of providing mental health services during a pandemic. Our Tier 1 UW Population Health pilot grant helped us better understand how burnout uniquely manifests for QTBIPOC therapists.

We utilized the Copenhagen Burnout Inventory (CBI) with our pilot sample as well as focus groups. The CBI measures participants’ level of burnout using 21 items on three subscales. These subscales use a 5-point Likert scale and have high internal consistency as follows: personal burnout (a=0.87), work related burnout (a=0.87), and client-related burnout (a=0.87). QTBIPOC therapists overwhelmingly indicated that they felt high levels of personal burnout and work-related burnout. For personal burnout, the sample indicated that they always/to a very high degree (AVHD) or often/to a high degree (OHD) felt the following ways: 1) tired (70.6%), 2) physically exhausted (64.6%), 3) emotionally exhausted (58.9%), and 4) worn out (58.9%). For work-related burnout, the participants reported AVHD or OHD levels for the following items: 1) worn out at the end of the working day (94.2%), 2) work is emotionally exhausting (76.5%), 3) work feels frustrating (82.4%), 4) feel burnt out because of work (53.0%).

QTBIPOC therapists did not, however, indicate high levels of client-related burnout. Focus groups did reveal that working with white clients can lead to some feelings of client-related burnout. One therapist explained, “Sometimes I’m more drained when I’m working with my white clients [because] I’m working with clients who are taking more from me…Clients of color give a lot to me.” Another clinician reported that working with QTBIPOC clients can protect against client-related burnout. They explained, “Working with QTBIPOC clients tends to be incredibly rewarding and I think that’s the space where I felt some sort of sense of reciprocity.”

Our two community-based agencies are currently almost entirely dependent on client sessions as the sole revenue source that sustains the organizations. Clinicians, however, have explained that seeing 25 clients a week feels unsustainable long term, particularly when many of these sessions are virtual. One therapist explained, “That’s actually the max [25 sessions a week] that I can do because there’s burn out. But if there is some variety of the things that I can offer that would actually go longer.” Another clinician expressed, “I can’t do full time therapy. I just know that I wouldn’t be able to handle that emotionally.” Clinicians also expressed how doing virtual therapy feels more difficult than in person therapy. One therapist stated, “There’s a mental load to tracking all that extra information [for virtual therapy sessions] and to holding your boundaries of making sure you actually get up and go downstairs and come back up [between sessions].” Another therapist discussed, “[B]ack-to-back [sessions] with virtual just feels super draining compared to in person work.” As the COVID-19 pandemic quickly shifted therapy to a telehealth format, this mode of therapy is likely to remain prevalent as a way to deliver therapy.

Some of the major themes uncovered from the focus groups related to QTBIPOC therapist wellness included: 1) financial wellness; 2) how working with white and/or heterosexual clients can contribute to exhaustion and burnout; 3) the importance of being in community for maintaining wellness; 4) serving 25 clients each week feeling unsustainable; 5) needing space to process internalized racism that has not been healed from previous graduate school or work-related experiences; and 6) physical wellness.

Turning to Sunshine: Developing a CBT-based Depression and Adherence mHealth intervention for HIV-positive Men Who Have Sex with Men (MSM) in China Using a Community-Based Participatory Approach

Investigators
Liying Wang, Department of Psychology
Jane M. Simoni, Department of Psychology
Weichao Yuwen, School of Nursing & Healthcare Leadership (UW Tacoma)
Huang Zheng, Shanghai CSW&MSM Center, SCMC

Project summary
The project aimed to achieve the following goals: 1) Establish a trusting and mutually beneficial partnership with the community-based organization Shanghai CSW&MSM Center, China; 2) Form an intervention team that involves community members, representatives from government institutions, healthcare providers, and researchers; 3) Complete needs assessment as a team; 4) Determine intervention priorities by triangulating the results from needs assessment with theories and empirical evidence, taking into account both what is important and what is changeable; 5) Develop a logic model to visually present intervention development and next steps.

We successfully achieved all the goals. We collaborated with our community partners and completed the needs assessment interviews with 17 MSM with HIV, 5 staff at Shanghai Centers for Disease Control and Prevention, and five staff at Shanghai CSW&MSM Center (SCMC). The manuscript reporting the results of the needs assessment was submitted to the British Journal of Health Psychology and is currently under review. We identified the high demands for psychosocial support and the mental health service gaps in the community. Using the results from the needs assessment and online co-design of intervention, we developed a Dialectical behavior therapy (DBT)-based intervention that was tailored to the community’s unique needs and cultural context. The manuscript reporting the intervention content and delivery was submitted to the Journal of Medical Internet Research: Formative Research and is currently under review.

Building Community Capacity Among MultiCare, Tacoma Public Schools, and University of Washington to Support Underserved Youth Well-being

Investigators
Chieh (Sunny) Cheng, School of Nursing and Healthcare Leadership (UW Tacoma)
Lucas McIntyre, MultiCare Tacoma General Hospital
Susan Ramos, MultiCare Health System

Project summary
Our proposed capacity-building project aims to strengthen an established partnership between UW Tacoma, Tacoma Public Schools (TPS) and MultiCare Behavioral Health and conduct a needs assessment that will inform the development and implementation of a transferable consultation program that supports student mental well-being. The partnership continues to grow and generate additional community engagement work including delivering substance use prevention lectures in the Stadium High School and implementing teens Mental Health First Aid training for the Healthcare Careers Academy students in Tacoma Public Schools.

Based on the results listed on the progress report, we started offering monthly case consultations (n=10) to school personnel (N=22), mostly school counselors. TPS emailed the staff about the opportunities to discuss with our co-PI Dr. McIntyre about children’s behavioral health challenges. During the one-hour monthly session, we received various case questions including selective mutism, stigma toward mental illness, internalizing concerns such as distressing emotions, community and clinical resources for referrals, culturally appropriate communication with family caregivers, and so forth. We implemented a 10-item self-efficacy scale before and after each session along with demographic questions to evaluate the efficacy of the program. Each of the ten questions in the self-efficacy scale covers different areas of behavioral challenges such as internalizing concerns (i.e. depression), suicidal thoughts, and so forth.

We have found the changes of participants’ self-efficacy levels of the particular behavioral challenges are associated with the topics we had discussed in the meeting. The anticipated longitudinal data collection will be done by May 2023. For the dissemination of this project funded by the Population Health Initiative, we have been invited to present a poster in the 14th IEPA Early Intervention in Mental Health Conference in Switzerland.

Risk-taking Behaviors and Cryptocurrency Trading (REACT) in Young Adults

Investigators
Caislin Firth, Department of Psychiatry & Behavioral Sciences
Jessica Beyer, Center for the Studies in Demography & Ecology (CSDE)
Christopher Barnes, Foster School of Business
Marieka Klawitter, Evans School of Public Policy & Governance

Project summary
This project had three articulated research aims. Aim 1 was identifying how young adults use cryptocurrency and its relationship to financial stress, debt, and well-being through an analysis of news coverage and Twitter posts. The work for Aim 1 considered news coverage and Twitter posts about cryptocurrency trading published between January 2021 and June 2022 in order to gain preliminary insights into public perceptions of cryptocurrency and the effects trading may have on young adults and their mental health. This time period was exceptionally tumultuous for cryptocurrency holders, with Bitcoin reaching an all-time high in November 2021 and then dropping by 30% in the summer of 2022. We looked at content related to risk perceptions of cryptocurrency trading, financial stress and debt, and personal-wellbeing or affect. We focused on newspaper articles and media coverage in English and publicly available to individuals, occasionally with a soft paywall. The articles in our sample covered news and events in the United States between January 2021 and June 2022. We relied on the Ad Fontes Media rating database to evaluate the credibility and political leaning of these sources. Overall, we found that news coverage of cryptocurrency trading appeared relatively balanced, reflecting its high-risk nature while at the same time recognizing its appeal among traders.

In addition, we leveraged the Kaggle dataset Bitcoin Tweets. With over four million tweets, this dataset is a continually updated collection of tweets containing the hashtags #bitcoin and #btc. We focused on tweets published between January 2021 and June 2022 by users located in the United States. We ran sentiment analysis on those tweets using VADER (Valence Aware Dictionary and Sentiment Reasoner) to understand users’ overall sentiment towards cryptocurrency and to find any changes in sentiment towards cryptocurrency trading from month to month. To do so, we used the code by the same Kaggle author as the Bitcoin Tweets dataset, Bitcoin Tweets Sentiment Analysis. We directly compared two periods of interest: October to November 2021 when Bitcoin reached an all-time high, and May to June 2022, when it dropped 30% in value. Unsurprisingly, while average tweet sentiment remained positive overall during both time periods, it is notably higher in October to November 2021 than in May to June 2022.

Overall, our results indicated mixed public perceptions of cryptocurrency, reflecting the volatility of the market, the relative novelty of the currency, and its complex nature. Our cursory analysis of news coverage did not find any content connecting cryptocurrency trading and mental health, but given that our sample period ends precisely when the most recent cryptocurrency crash occurred, we would recommend that our analysis be repeated for the months following the crash. Our sentiment analysis found a decrease in positivity of average sentiment when bitcoin’s valuation dropped in May/June 2022 compared to its peak in November 2021.

Aim 2 was to assess the feasibility of recruiting a cohort of young adult cryptocurrency traders from online forums. The focus was to engage in investigative observational research in online communities, such as sub-reddits or posting boards. The aim was to identify major cryptocurrency focused online forums, propose forums for introductory observational research, and unpack community dynamics that might impact recruitment. The team created a comprehensive list of major cryptocurrency forums, identified which of these forums had formal rules in place prohibiting researchers from studying the forum, identified forums that would be good candidates for observation, and spent several weeks observing these forums and gathering information about them including cultural characteristics that would impact recruitment. The team also identified other researchers at UW conducting research into cryptocurrency online spaces and reached out to them. Our findings were not optimistic for recruiting from these forums. Community suspicion of outsiders, a culture of posting untrue information to foil observers, and concerns about researchers who pathologize cryptocurrency trading all serve as barriers. However, observational research is feasible. Research that compares behaviors, self-perceptions and attitudes might be particularly fruitful, including demographic comparisons (if possible to identify), and comparisons of cryptocurrency investment tactics in altcoin (versus Bitcoin) forums. However, this would both be challenging because of the anonymity in forums as well as the widespread cultural practice of deceiving anyone who might be reading forum posts.

Exploring COVID-19 Vaccine Hesitancy in Pregnant Rural Washingtonians

Investigators
Kristina Adams Waldorf, Department of Obstetrics & Gynecology
Kolina Koltai, Information School
Rita Hsu, Confluence Health
Linsey Monaghan, North Olympic Healthcare Network
Shelby Wilson, Department of Communication
Alex Stonehill, Department of Communication
Ekta Dokania, Department of Communication
Lauren Marcell, School of Medicine

Project summary
In this project, we performed 60 direct interviews of English-speaking (N=30) and Spanish-speaking (N=30) pregnant or recently pregnant individuals in the Western U.S. (Washington, Idaho, Oregon, California, Nevada) to determine their opinions on vaccination in pregnancy and on digital content promoting vaccine uptake. We recruited participants using social media ads displayed to Facebook and Instagram users living in rural zip codes with an interest in pregnancy and newborn-related products. Next, we performed a mixed methods study to investigate factors linked to vaccine acceptance and hesitancy in pregnancy, as well as reaction to social media ads promoting COVID-19 vaccination with different messengers and types of message content (activation, social proof, appeal to protect, negative outcomes-based content). Interviews were transcribed and coded thematically. Social media ads were rated on a Likert scale and analyzed using linear mixed models.

In the interviews of English-speaking participants, we identified five main themes related to vaccine uptake, including perceived risk of COVID, sources of health information, vaccine hesitancy, and relationships with care providers. Participants rated ads most highly that used peer-based messengers and negative outcomes-based content (Fig. 1A). Ads with faith-based and elder messengers were rated significantly lower than peer messengers (p=0.04 and 0.001, respectively). Ads depicting doctors were rated similarly to those of elder messengers and less favorably than peer messengers.

Next, we investigated respondents’ preferences to the ad content. Negative outcomes-based ads were set as the reference category as they were the most favorably ranked content type. An activation message was also rated significantly less favorably than negative outcomes-based content (p=0.001). Participants preferred evidence-based information and the ability to conduct their own research on vaccine safety and efficacy rather than being told to get vaccinated. Primary concerns of vaccine-hesitant respondents included the short amount of time the vaccine had been available and perceived lack of research on its safety during pregnancy. Our findings suggests that tailored messaging using peer-based messengers and negative outcomes-based content can positively impact vaccine uptake among English-speaking pregnant women living in rural areas of the Western United States. A manuscript describing these findings is currently in revision with Vaccines.

Using Learning Labs to Address Racial and Ethnic Disparities in School Discipline and Policing in King County, Washington

Investigators
Monica Vavilala, Harborview Injury Prevention and Research Center, Department of Anesthesiology and Pain Medicine
Keith Hullenaar, Harborview Injury Prevention and Research Center, Department of Epidemiology
Marcus Stubblefield, King County Executive Office, Office of Performance, Strategy, and Budget
Chelsea Hicks, Harborview Injury Prevention and Research Center, Department of Pediatrics

Project summary
This proposed pilot project aims to address out-of-school suspension disparities through designing a pilot school-based learning lab—a research-based process that brings together local and diverse stakeholders to inclusively problem solve about racial and ethnic disparities in school discipline and policing.

We expanded our local stakeholder relationships in three specific ways. First, we identified learning lab (now titled Community Collaboratives on School Safety [CCSS]) champions in Tukwila School District. These champions include the superintendent, principal of Foster High School, and the principal of Showalter Middle School. Second, we have established contact and interest for the CCSS process in Educational Service District 105 in Yakima, WA. This organization is specifically interested in using the CCSS process to better implement SRO training in local school settings to promote school safety, equity, and youth health. Third, we are in the process of discussing the CCSS process with Seattle Public Schools (SPS).

In partnership with Tukwila School District and the CCSS champions, we examined racial and ethnic disparities in school discipline and policing outcomes (i.e., referrals to law enforcement and arrests) in Tukwila schools using publicly available data from the Civil Rights Data Collection. This needs assessment was part of a larger effort to assist Tukwila in addressing racial and ethnic equity through reforming their school resource officer (SRO) program.

Finally, we completed and pilot tested a executing a learning lab (i.e., CCSS) in Tukwila School District. Tukwila School District desired a more rapid implementation of the learning lab process to help reform their SRO program to promote racial and ethnic equity, trust and relationship building, and school safety, so we worked with the CCSS champions to both design and execute the intervention.

Amazonian Green Cities: A Gardens Program for Health, Ecology, and Climate Change Resilience

Investigators
Dr. Joseph Zunt, Departments of Global Health and Neurology
Jorge “Coco” Alarcón, School of Public Health
Dr. Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Gabriela Vildósola, Acuerdo por Iquitos
Susana Cubas, Asociación de vecinos de Calle Yavari
Rebecca Bachman, College of Built Environments, Landscape Architecture

Project summary
Iquitos, home to half a million people, is the largest city in the Peruvian Amazon region and one of the most arid cities in Peru, with only 1.2 sqm of green space per capita. The city’s environmental conditions cause multiple crises, including the urban heat island effect, loss of biodiversity, and severe outbreaks of infectious diseases like dengue fever and leptospirosis. The HAGC program aims to promote the design, construction, and maintenance of green spaces to improve human health, ecology, and environmental conditions (One Health) in Iquitos.

The pilot phase of HAGC had two main goals. First, to define the program components, tools, and methods to systematically implement HAGC. Second, to assess the preliminary impacts on One Health and the implementation outcomes of HAGC. To achieve this, the team built on previous experiences with a community-based garden program in Iquitos that addressed One Health, including a previous PHI project, and used a design thinking approach that included the participation of three families, who received the preliminary version of the program, residents, gardening experts, ecological and environmental researchers, and public health actors. After this process, the team refined the program and implemented it in 30 households to assess the preliminary impacts and implementation outcomes. The team has secured funds to implement the program in 30 additional households (the control group of this first phase) during October-December 2024, which would strengthen the evidence generated from the project.

One of the preliminary findings of this phase is the identification of the role that gardens play in the severe dengue outbreaks that emerge every year. The environmental conditions of residential gardens, commonly considered a risk factor for Aedes aegypti mosquito (dengue vector) breeding, are a key piece not included in local dengue control strategies. Local governments use general, inaccessible educational material and ineffective and unsustainable fumigation campaigns that cost 1.2 million dollars per year (2018) in Iquitos. Our preliminary results provide evidence that with outreach education, participative design approaches, and incentives, residential gardens could sustainably eradicate the risk of Aedes aegypti breeding and even create habitats for mosquito predators. Other project findings are the benefits garden provided to mental health and well-being, physical activity, food security, biodiversity, and the abundance of local species. The project is also documenting the changes in temperature and water cycles at the residential scale. The systematic implementation of the program, and the consequent increase of green spaces, could contribute to the mitigation of the heat island effect and support strategies for the mitigation of climate change.

In terms of implementation outcomes, the program improved the acceptability, appropriateness, feasibility, and adoption of green spaces. Participants expressed that through this program, they learned the relevance of gardens and how to build them according to their needs. One participant stated, “I couldn’t be happier with my garden; I wouldn’t change anything in the program.” However, the program still faces several challenges for large-scale implementation. During this pilot phase, the team added graduate students from Human Centered Design to refine the educational and design materials for future phases. Local community-based initiatives and indigenous Kukama groups have partnered with our team to co-create city composting systems to sustainably produce soil to support the program. This new partnership has been awarded funding by UW Earth Lab. Furthermore, the team anticipates scaling HAGC using local social networks to reach a more diverse group of households and to study the large-scale impacts and cost-benefit of implementing HAGC at the city level.

Sleep Health in People Experiencing Homelessness

Investigators
Horacio O. de la Iglesia, Department of Biology
Melanie Martin, Department of Anthropology
Zack W. Almquist, Department of Sociology, Department of Statistics
Amy Hagopian, Departments of Global Health and Health Systems & Population Health

Project summary
The goals for this award were: (1) to identify the relationship between a variety of homeless housing alternatives and sleep quality, (2) develop noninvasively measured sleep as standard metric of the impact of any intervention to combat homelessness, and (3) determine the predictive value of sleep parameters for adverse physical and mental health outcomes.

We collected sleep recordings from 22 participants living in four homelessness communities: (1) A Tiny House community in North Lake Union, (2) A Tiny House community in the Central District, (3) a Permanent Shelter in South Seattle, and (4) a Tent City community in the University District. Each participant wore a wrist actimeter for four weeks, completed a general demographic/health survey and daily sleep, mood and sleepiness survey, and provided biomarker data that included blood pressure, white blood cell count, and stress and inflammation blood markers.

Overall our study has revealed that our strategy to record wrist activity is highly sensitive to detect differences in activity patterns between homeless communities in which daily activity is impacted differently by seasons. Although we are still analyzing data, it is unlikely that effects of community and season on specific sleep parameters will not emerge from this analysis.

Misinformation Escape Room: Building a Research Agenda for a Gamified Approach to Combating Health Misinformation

Investigators
Chris Coward, Information School
Julie Kientz, Department of Human Centered Design & Engineering
Kolina Koltai, Information School
Jin Ha Lee, Information School
Rachel Moran, Information School

Project summary
This Tier 1 project aims to develop a research agenda for a gamified approach to building resilience to public health misinformation. The overarching goal of this project was to develop a research agenda that incorporates expertise on misinformation, games, and health informatics. The supporting goals were to co-design a proof-of-concept public health escape room, and run a pilot study to generate data for grant proposals and publications.

We achieved our overarching goal of developing a research agenda. This included assembling an expanded UW team that met regularly throughout the year, developing a partnership with the Fred Hutch Cancer Center, and identifying a particular health topic — cancer nutrition misinformation — for the development of the game intervention. With this focus we undertook a literature review, collected examples of cancer nutrition misinformation from social media sites, and conducted 10+ expert interviews with cancer nutritionists and oncologists. These activities allowed us to both understand how and why patients believe certain types of misinformation and elicit input on design elements for game development. We synthesized all of this information into a design brief which has formed the basis for designing the prototype escape room and pilot study.

In the course of this project, our partnership with the Fred Hutch led us to take advantage of funding opportunities and situate the supporting goals (prototype escape room and pilot study) within a broader, strategic effort. Namely, we joined forces with a larger team at the Fred Hutch that is putting together a large five-year application for an NIH PO1 grant. In making this shift in priority, we slowed the development of the prototype and pilot study so that we could synchronize with the PO1 effort and tailor our pilot study to generate data that will be critical for this application. To support this longer timeline we applied for and received a small NIH grant from the Network of National Libraries of Medicine that runs through April 2023. This will allow us to complete the prototype and data collection for the pilot study. We also submitted a grant to the Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium to support ongoing analysis and preparation of the PO1 grant, with a decision expected in March.

With regard to dissemination, our proposal was accepted for presentation at the 2023 NNLM Virtual Symposium on Health Misinformation, and we have drafted a paper that we are in the process of finalizing for submission to a journal.

My Toddler’s Social Communication: Examining the Cultural Sensitivity of a New Pictorial Screening Tool for Identifying Toddlers at Risk for Autism in Diverse Cultural, Ethnic, Racial, and Linguistic Settings

Investigators
Shana Attar, Department of Psychology
Wendy Stone, Department of Psychology
Juliette Escobar, King County’s Best Start for Kids

Project summary
Children with autism from diverse cultural, ethnic, racial, and linguistic backgrounds are diagnosed less frequently and at older ages than White children, delaying access to autism-specialized treatment. This identification and treatment delay is associated with a profound lag in cognitive, linguistic, and social development relative to children who receive timely diagnoses and autism-specialized treatment. One contributing factor to inequitable autism identification is that current screening tools have been validated on primarily White families and are not sensitive to how caregivers from diverse backgrounds interpret questions nor to their expectations of normative social behavior from their children. As a result, multiple studies have documented that current autism screening tools work less well for children from diverse backgrounds compared to White children. There is therefore a great need for accurate screening tools that can be used by frontline providers working in multicultural settings.

For this project, we examined the cultural sensitivity of “My Toddler’s Social Communication” (MTSC), an 11-item novel autism screening tool under development in our lab. Our goal was to explore the feasibility, acceptability and cultural sensitivity of the behaviors, language, and photos included in the survey. We partnered with two local community organizations that work with diverse families to administer surveys and host focus groups. We conducted two pilot rounds, following the Plan-Do-Study-Act procedure. In the first round we obtained feedback on the initial survey items, and in the second round we solicited feedback on the revised questions. We had 115 total participants across the two piloting rounds.

Feedback from the first pilot revealed that the survey had high feasibility and acceptability, but the cultural sensitivity of the behaviors could be improved (3 question items), and the wording could be clarified (3 question items). Caregivers also suggested that the photos illustrate a greater diversity of children and play examples. We revised six items before the second round of piloting to accommodate this feedback; for example, the item, “enjoys playing with same-aged peers” was changed to “enjoys playing with children” to reflect feedback that many children do not participate in single-age play groups and instead interact in more family- or community-based groups that include children across multiple ages. Results from the second round of piloting suggest that four of our six revised items are acceptable; two items remained difficult to accurately interpret, although the behaviors were culturally sensitive.