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Asian Pandemic influenza community outreach (APICO) Program: Integrating Cultural and Linguistic Competence with Pandemic Influenza Preparedness . APICO Program is made possible through funding from the Illinois Department of Public Health. By Jessica Szafron, BA and Hong Liu, PhD

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by jessica szafron ba and hong liu phd midwest asian health association

Asian Pandemic influenza community outreach (APICO) Program: Integrating Cultural and Linguistic Competence with Pandemic Influenza Preparedness

APICO Program is made possible through funding from the Illinois Department of Public Health

By Jessica Szafron, BA and Hong Liu, PhD

Midwest Asian Health Association

  • About MAHA
  • Community Overview, Needs, and Partnership Model/Training Model
  • Program Goals and Structure
  • Program Training, Material, and Tools
  • Outcome and Summary

About Us

Who We Are

The Midwest Asian Health Association (MAHA) is a community-based 501(c) (3) non-profit organization located in Chicago South Chinatown.

Mission Statement

MAHA’s mission is to reduce health disparities in Asian

American & Pacific Islanders (AAPIs) through providing culturally and linguistically appropriate services and community outreach including education, research, screening, immunization, capacity building, and policy advocacy.


MAHA Community Health Center

& Month Health Screening Clinic


Chinese American Mental Health Initiative (CAMHI)

In November of 2010, we launched the first Chinese

American Mental Health Initiative with over 70 Chinese organizations signing on in supporting the Initiative

all kids care program
All Kids Care Program
  • Partner with the Mount Sinai Community Health Institute
  • Working with Asian community based organizations
  • Increase the enrollment of Asian kids in public aid

Policy Advocacy:

Asian Executive Roundtable

survey results percent of adults ever diagnosed with diabetes
Survey Results: Percent of Adults Ever Diagnosed with Diabetes

US 7.5% (CDC, Behavior Risk Factor Surveillance System, 2006)

Age-Adjusted Prevalence

ten year population change among racial ethnic groups in chicago u s census bureau 1990 2000
Ten Year Population Change among Racial/Ethnic Groups in Chicago (U.S. Census Bureau 1990-2000)
asian community needs for pandemic emergency preparedness
Asian Community Needs for Pandemic Emergency Preparedness
  • Lack of knowledge about the immunizations that are needed and how often to get them.
  • Doubts that vaccines are effective in preventing illness and not believing they were at risk for a vaccine-preventable illness
  • Fear of side effects and misconceptions about immunizations, particularly the myth that influenza vaccine can cause the flu.
  • Lack of priority given to preventive health or forgetting about immunization,
  • Distrust of healthcare providers.
  • Lack of health insurance with limited access to healthcare and no usual source of care
  • Cultural and language barriers to pandemic flu emergency information
  • Lack of community infrastructure for emergency preparedness
  • Lack of funding for programs and resources
asian community partnership model
Asian Community Partnership Model
  • Availability of bilingual assistance
  • Cultural sensitivity
  • Trusting relationship
  • Convenience
  • Recruitment strategy
  • Availability of local media awareness
lay health advisor model
Lay Health Advisor Model
  • Bilingual with immigrant background
  • Language and culturally competent
  • Strong social network
  • Respect and trust
  • Skills and experience to deliver health messages
goal 1
Goal 1
  • Goal 1: Build community awareness and infrastructure for pandemic influenza preparedness in the underserved Asian communities in suburban Cook County, DuPage County, Kane County, and Will County
objectives of goal 1
Objectives of Goal 1
  • Objective 1.1: Create an Asian Coalition for Pandemic Influenza Response (ACPIR) and build a network and an infrastructure in the target communities
  • Objective 1.2: Promote community awareness about pandemic influenza prevention and response and the Coalition through a media campaign
  • Objective 1.3: Build a resource directory for pandemic influenza preparedness and collaborate in the target communities in the suburbs of Chicago
goal 2
Goal 2
  • Goal 2: Improve community educational efforts for pandemic influenza education by developing and providing training to Lay Health Advisors and Peer Educators using culturally sensitive and scientific methods that address not only the risks, but also the barriers to immunization for the hard-to-reach populations with low English proficiency
objectives of goal 2
Objectives of Goal 2
  • Objective 2.1: Develop language appropriate curricula for the seasonal and pandemic influenza training to Lay Health Advisors and Peer Educators
  • Objective 2.2: Recruit the Lay Health Advisors (LHA) from each CBO and provide training to 25 LHAs
  • Objective 2.3: Recruit Peer Educators from each CBO who will be trained by the Lay Health Advisors (LHA) at each community site (total: 125 Peer Educators)
goal 3
Goal 3
  • Goal 3: Provide program evaluation to assess the impact of the program and the Coalition, and develop strategies for program sustainability
objectives of goal 3
Objectives of Goal 3
  • Objective 3.1: Establish a database for project progress and outcome evaluation
  • Objective 3.2: Submit monthly report to IDPH Center for Minority Health for program feedback
  • Objective 3.3: Search for future funding opportunities and submit grant proposal to sustain the Coalition and expand the education efforts to other Asian communities in Illinois
network structure
Network Structure
  • Public Health Departments:
    • Illinois Department of Public Health
    • Cook County Department of Public Health
    • DuPage County Health Department
    • Kane County Health Department
    • Will County Health Department
network structure1
Network Structure
  • Community-Based Organizations
    • Metropolitan Asian Family Services (MAFS)
    • Xilin Association
    • Chinese-American Association of Greater Chicago (CAAGC)
    • Lao-American Organization of Elgin (LAOE)
    • Hanul Family Alliance
network structure2
Network Structure
  • Immunization Providers
    • Public Health Department Immunization Coordinators
    • Pharmaceutical distributers (Supervalu Pharmacies, etc.)
      • Covers Albertsons, Jewel Osco, Shop ‘n Save, Cub, etc.
    • Vaccine For Children (VFC) Participants
  • Train-the-trainer model
  • Each CBO will identify 5 bilingual lay health advisors (LHA) and, in conjunction with MAHA staff, will provide pandemic influenza training to them at the community site
    • 5 CBOs X 5 LHAs = 25 lay health advisors trained
  • Each LHA will each provide pandemic influenza training to 5 peer educators that are fluent in their respective languages under the guidance of the CBO
    • 25 LHAs X 5 peer educators = 125 peer educators trained
  • Peer educators will work to educate their respective communities
    • 25 LHAs + 125 peer educators = 150 people trained
acpir advisory board meetings
ACPIR Advisory Board Meetings
  • April 21
  • June 27
  • August 23
media promotion1
Media Promotion
  • Xilin
    • Mandarin PSA in Xilin Newsletter during week of June 22 and Xilin’s website shortly thereafter
  • Hanul
    • Korean PSA in KoreaDaily and KoreaTimes and newspaper article in KoreaDaily on April 26, 2011
    • Mandarin PSA sent to World Journal, Suncast TV, China Star Media, World Chinese Weekly, Sintao News, China Journal, Healthy Today, Chinese News Digest,, and and promotion at Chinatown health fair
  • LAOE
    • Laotian PSA posed at Lao stores, Buddhist temples, and churches in the Elgin area
  • MAFS
    • Hindi and Gujrati PSA in Gujarat Darpan, Desitalk Chicago, and Sandesh Newspaper
maha lay health advisor trainings
MAHA Lay Health Advisor Trainings
  • May 5: 18 LHAs trained by Jessica Szafron
    • Metropolitan Asian Family Services (MAFS)
    • Xilin Community Center (Xilin)
    • Hanul Family Alliance (Hanul)
  • May 9: 2 LHAs from CAAGC trained by Jessica Szafron
    • Chinese American Association of Greater Chicago (CAAGC)
    • Lao-American Organization of Elgin (LAOE)
cbo trainings
CBO Trainings
  • Xilin peer educator training- June 15
training material
Training Material
  • What is influenza?
  • Types of influenza
  • Seasonal flu and its symptoms
  • Pandemic flu: what it is, severity, and examples
      • Swine flu, Avian flu
  • Antigenic shift of the virus
  • Most at-risk populations
  • Flu complications and prevention
  • Vaccinations
  • Flu treatment
  • Planning & responding to an outbreak
evaluation results
Evaluation Results
  • Standard Pre/Post Test with 20 questions was utilized in some trainings
    • MAHA- 17.61% improvement rate
      • 12.5% increase in points
        • 71% 83.5%
    • Xilin- 32.13% improvement rate
      • 22.92% increase in points
        • 71.33% 94.25%
    • LAOE- 27.96% improvement rate
      • 20.35% increase in points
        • 72.78% 93.13%
    • CAAGC- 25% improvement rate
      • nearly 20% increase in points
        • 80% nearly 100%
    • MAFS- N/A
    • Hanul- N/A
  • Test was translated in some cases
  • Established ACPIR advisory board
    • Improved relationship between health department’s, vaccination providers, and CBOs
    • Strengthened network of community resources, assets, knowledge, skills
    • Increased knowledge and awareness of pandemic influenza among CBOs and other stakeholders
    • Increased provider understanding of barriers to vaccination among AAPIs
    • Improved collaborations among Coalition members
    • Improved commitment to Pandemic influenza prevention
  • Trained 229 LHAs and peer educators from across Indian, Chinese, Korean, and Laotian communities
    • Improved knowledge among the target communities about education and immunization resources
    • Increased awareness about flu immunization
    • Reduced barrier to immunization
    • Improved understanding of seasonal and pandemic influenza
    • Improved knowledge about the system and preparedness
    • Improved utilization of public resources
  • Released bilingual PSAs and press releases
    • Culturally appropriate educational materials, flyers, evaluation tools developed to be used to effectively educate the target clients, program evaluation improved
    • Increased media & community awareness about Coalition and program messages.
  • Created and utilized pre/post-test for training evaluation
    • Outcome evaluation demonstrated improved clients’ knowledge and behavior change
    • Improved impact of the program
    • Identified challenges for improvement
  • Created resource directory
    • Improved community infrastructure to address the disease
lessons learned
Lessons Learned
  • Lay Health Advisor model is an effective strategy to outreach to the hard-to-reach Asian, immigrant, LEP populations
  • Translation of material increases community interest and involvement
  • Establishing relationships between immigrant communities, CBOs, and health departments strengthens public health overall