Awardees of winter 2023 Tier 1 pilot research grants report final project outcomes

Socioecological conflict in Brazil: Equitable land tenure, ecosystem destruction, and health

Investigators
Julianne Meisner, Department of Global Health
Peter Rabinowitz, Department of Environmental & Occupational Health Sciences
Kevin Bardosh, Department of Environmental & Occupational Health Sciences
Tabata Berg, State University of Campinas
Emilio Nieto, University Center of Viçosa
Krista Jacobs, Landesa

Project summary
For centuries prior to abolition in Brazil, the regional biomes of the Amazon, Pantanal and Cerrado served as refuge to those escaping from enslavement on plantation farms, who peacefully co-habited with Indigenous populations in communities known as Quilombos. Combining the agricultural knowledge of their founders with teachings from Indigenous communities, today Quilombola farmers have established agroforestry systems throughout Brazil. Our project was located in Mata Cavalo, a complex of six Quilombola communities in Mato Grosso state in the midwest of Brazil, at the intersection of the Pantanal (wetland) and Cerrado (savannah) biomes. Each community in Mata Cavalo is formed around an ancestral trunk: a single ancestor who founded that community after abolition. Mata Cavalo began process of securing a title to their land in 2007, but the process has stalled in court.

Our central objective was to characterize the nature of land conflicts in Mata Cavalo, and their impact on the integrity of the surrounding biomes. To meet this objective, we conducted qualitative and quantitative data collection between June and December of 2023 in three of the six communities of Mata Cavalo: Ribeirão da Mutuca, Mata Cavalo de Cima and Capim Verde. Methods included ethnographic immersions, in-depth interviews, participatory mapping and structured questionnaires. Data collection was supported by the work of two community researchers—one youth and one elder—appointed by community leaders, two Brazilian co-investigators, and two Brazilian undergraduate students.

Our results indicate that the importance of the territory of Mata Cavalo is multifaceted: it is a rescue site of memory, identity and connection to ancestors; a locus of economic production, wellbeing, and kinship; and a place of rights reclaimed and resistance against racism and sexism. Within the territory, the Quilombola way of life is centered on slash-and-burn cultivation or “roças de toco,” a practice which is interconnected with the Cerrado and Pantanal: the security of these biomes is a necessary condition for continuity of the roças de toco and thus the Quilombola way of life, and in turn, the Quilombola way of life promotes the security of these biomes.

We found that external and internal threats to the territory of Mata Cavalo are constant. Internally, conflicts between those who stayed and those who were expelled in the 1980s and 90s and later returned have impacted the Quilombola way of life and the security of these biomes, due to loss of the traditional knowledge needed to maintain a livelihood from the roças de toco. Externally, the greatest threat to the territory is capitalist commodity production, particularly agribusinesses (cattle and soy) and large-scale gold mining operations. While exploitative labor and land tactics have characterized capitalist modes of agricultural production in Brazil since colonization, these practices became intensified in the second half of the last century with the introduction of new technology and growing export markets. This model is practiced in Mata Cavalo by non-Quilombola groups (landless workers, land grabbers and White farmers) who have appropriated land, with or without illegitimate purchase, in the Quilombola territory. These internal and external threats are coinciding with attempts to erase both the existence and culture of Quilombolas, who are finding that despite having won the right to hold a title for their lands, the ability to enact this right has not yet materialized.

In addition to our research objectives, we were requested by the community to host two workshops as an alternative to individual participant incentives/compensation. In June, we organized a half-day workshop on Quilombola identity, history and resistance, facilitated by an expert in Brazilian social thought and critical race theory from the University of Sao Paulo. In July, we hosted a two-day workshop facilitated by a Brazilian attorney on federal and international rights of traditional peoples and communities, specifically legislation concerning Quilombola communities and land rights, available legal assistance for communities seeking to access affirmative Quilombola public policies and opportunities to build a network of solidarity.

Understanding unmet needs among people with violence-related spinal cord injury: A mixed methods study

Investigators
Heather M. Barnett, Department of Rehabilitation Medicine
Deepika Nehra, Department of General Surgery
Catherine Wolff, Department of Anesthesiology & Pain Medicine
Chelsea Hicks, Department of Pediatrics
Deborah Crane, Department of Rehabilitation Medicine
Jeanne Hoffman, Department of Rehabilitation Medicine
Monica Vavilala, Department of Anesthesiology & Pain Medicine

Project summary
The project team completed their analysis of outpatient care of people with spinal cord injury (SCI) due to violence who live in King County using data from the Harborview Trauma Registry and electronic medical record. We found that individuals with violence-related SCI received less outpatient services, including SCI physician, physical therapy, occupational therapy and recreational therapy services, compared to individuals with other traumatic etiologies of SCI, as we had hypothesized. A manuscript with these findings are now published in the journal PM&R. In addition to the outpatient care received by this patient population, we also evaluated the details of surgical care provided to patients with violence-related SCI. We found that there were significant differences in timing of spine surgery and in injury severity based on violent vs. non-violent etiology of injury. Individuals with firearm-related SCI were less likely to have surgery and had a longer time to surgery compared to individuals with other causes of SCI. A manuscript reporting these findings is now published in the Journal of Spinal Cord Medicine.

In addition, we collected qualitative data on the experiences of individuals with SCI due to violence through an online survey and interviews. We developed a questionnaire and interview guide to investigate patient perception of access to care (including barriers and facilitators such as transportation access, distance, community support, and healthcare system issues), patient-identified met and unmet needs, patient opinion on current and past support programs for those who participated in these initiatives and suggestions for improvement. We developed these research tools with input from relevant community advisory boards: the Northwest Regional Spinal Cord Injury System Community Advisory Board and the Harborview Injury Prevention and Research Center Community Advisory Board.

A novel and unanticipated discovery of this work involved the finding that a number of patients were injured during arrest or during interactions with the police. These injuries were not always coded as related to violence, and the involvement of law enforcement was not always specified in the mechanism of injury. Therefore, we investigated the frequency of law enforcement involvement in traumatic injuries among both patients with SCI and other patients with traumatic injury. A poster related to these findings will be presented at the Washington State Public Health Association Annual Conference in October 2024.

Understanding the needs of families caring for Chinese American older adults and opportunities for digital health tools to promote health equity

Investigators
Andrea Hartzler, Department of Biomedical Informatics and Medical Education
Serena Jinchen Xie, Department of Biomedical Informatics and Medical Education
Michael Woo, Kin On
Cindy Dong, Pacific Northwest Chinese Nurses Association
Weichao Yuwen, School of Nursing & Healthcare Leadership (Tacoma)

Project summary
In 2020, over 50 million family caregivers provided care for older individuals and people with disabilities in the US. Providing care to a loved one can be physically, financially, and emotionally stressful. In particular, Asian Americans and family caregivers of Chinese-speaking older adults reported high levels of emotional stress more often compared to English- or Spanish-speaking caregivers (Semere et al., 2019). Digital health tools have the potential to provide affordable and accessible real-time support for family caregivers. Yet creating such tools requires a foundational understanding of caregivers’ experiences and the shared needs specific to the community. In collaboration with our community partner organizations, we describe the needs of families caring for Chinese American older adults and the caregiving ecosystem. With this understanding, we identify opportunities for digital health tools to help address the unmet caregiving and self-care needs of these critical family caregivers. This project aimed to 1) Understand the needs of families caring for Chinese American older adults and the caregiving ecosystem (Aim 1), and identify addressable gaps and potential high-impact digital health solutions in partnership with collaborators from community-based organizations (Aim 2). This foundational knowledge is critical for developing tailored digital health tools to alleviate caregiver stress and improve care quality.

For Aim 1, we conducted 12 in-depth individual interviews with family caregivers caring for Chinese American older adults. Participants shared their caregiving challenges, self-care practices, acculturation and cultural values, and perspectives of using digital tools, especially chatbot, to address their challenges. For “caregivers challenges,” we found barriers to using formal resources and services was a recurring theme. This could be due to language barriers, immigration status, lack of understanding the system, and stigma associated with asking for external help. Another theme was the lack of social support for both older adult care recipients and the family caregivers. For “self-care practices” we found that (1) there is a lack of awareness of self-care, (2) the most common self-care practices are physical (e.g. hiking) and social (e.g. chatting with friends), while only one participant considered psychological or emotional self-care practices, (3) there exists stigma associated with mental health support, and (4) participants were very problem-solving focused and tied their wellbeing with solving the problem they experienced. For “acculturation,” we observed the theme of intergenerational and intercultural conflict that contributes to many caregivers’ challenges in communication, lifestyles, and mismatched expectations of caregiving. For “culture values,” in addition to the ‘familism’ and ‘filial piety’ which are identified in previous literature, we found that (1) high power distance (Hofstede 2010) between the older adult parents and adult children could be a facilitator to the inter-generational and inter-cultural conflicts, and (2) the ‘self-restraint’ cultural value (Hofstede 2010) may contribute to the association of ‘self-care’ with ‘indulgence’ and acclaim enduring hardship on one’s own rather than seeking external help.

For Aim 2, we established community partnerships with five local community-based organizations serving Chinese American older adults and their families. Staff from these organizations participated in focus groups. We conducted four focus groups with 21 participants of various positions in the caregiving ecosystem, including nine case managers or social workers, five nurses, four program managers or directors and three home care specialists. During focus groups, participants shared their experiences supporting Chinese American families with older adults, their observations of family caregivers’ self-care, and their perspectives on opportunities for digital health tools. Through the data from focus groups, we identified several opportunities for digital health innovations. These include offering real-time and trustworthy informational support on caregiving, guiding caregivers through system navigation and service discovery, sharing peer caregiver stories for scenario-based learning, suggesting communication strategies for adult children caregivers, and enabling family check-ins prior to or between case manager consultations. In discussions about chatbots, participants raised concerns regarding a chatbot’s capacity to offer culturally sensitive emotional support, alongside skepticism about its potential to substitute valuable human social interactions.

Community Healing: Lessons from Asian Organizers for Mental Health Providers

Investigators
Jondou Chase Chen, College of Education
LeiLani Nishime, Department of Communication

Project summary
The goal of this project is to learn about the experiences, values and the aspirations of Asian non-binary and women community educators, artists, healers and organizers who are invested in the mental and physical well-being of Asian communities in Seattle to inform a curriculum for a Continuing Education Unit workshop for mental health providers. By learning how they make sense of their experiences and how they bring their values to their respective community learning spaces, we seek to support mental health professionals in their practices in meaningful and sustaining ways for Asian clients.

For this project, we utilized Asian Critical Race Theory (AsianCrit) and Culturally Sustaining Pedagogy (CSP) as theoretical frameworks (Museus & Iftikar, 2018; Paris, 2012). AsianCrit addresses the ways Asian folks are racially positioned in the US, as well as the ways they engage in self-determination in the pursuit of intersectional and collective liberation. Further, CSP offers a perspective that values the importance of learning spaces that center Communities of Color, healing, restorative justice, and liberation; it offers the power to transform learning spaces (like a therapist’s or school counselor’s office) that actively disrupt of systemic violence and sustains the identities and cultures of Students of Color.

With 13 local Asian organizers, community educators, artists, and healers, the AsianCrit
Collective (research team) engaged in qualitative narrative inquiry via surveys, interviews, focus group sessions, and art-based reflections to learn about their experiences, values, and hopes. With thematic memoing analysis, we identified three major themes: 1) community partners saw their politics and activism as personal, 2) brought up caring for past, present, and future generations across various identities, and 3) desired access to refusal and choice, safety and joy, as critical pieces to cultivating a culture of care.

Therefore, to create a culturally sustaining mental wellness space for Asian youth across learning settings, we as educators, scholars, mental health practitioners/providers and organizers must 1) embody liberatory politics bridging our stories, theories, and praxis. We must also 2) build and lean on our constellations of care as this work requires solidarity and community effort.