Working to Build Trust in Minority Communities
April 6, 2017 | by Josh Jenisch
Having a conversation with Mayra Serrano is like talking to a particularly articulate freight train.
She exudes intelligence and aptitude in equal measure, explaining complex sociological problems and solutions in a simple, ultimately uplifting way.
“When you think about cancer and other life-threatening diseases,” she says, “ethnic minorities experience disproportionately poor life expectancy, unfavorable disease outcomes and mortality rates. It’s my job to help fix that.”
Though she speaks briskly, her enthusiasm for the work is palpable. She spends several days a week out in the community, identifying inequalities and then crafting programs to alleviate them.
Serrano, M.P.H., C.H.E.S., serves as the manager of CCARE, City of Hope’s Center of Community Alliance for Research & Education, established to improve health care access, disease diagnosis and treatment outcomes for ethnic minorities and others living in lower socioeconomic communities.
Trust, or a lack thereof, is often the biggest impediment to her success, she said.
“Mistrust is common among minorities,” Serrano said. “Especially immigrant and undocumented populations, who rarely want to share any information at all.”
She explained that minority populations lack trust in the health care system for many reasons, among them a history of discrimination and the failure of health care institutions to provide culturally sensitive care.
But Serrano, along with her colleagues in CCARE and the larger City of Hope community, are slowly but surely turning the tide.
The Power of Relationships
“Mayra does an amazing job creating partnerships and maintaining them,” said Noe Chavez, Ph.D., a community psychologist at City of Hope who, like Serrano, is charged with bridging the gap between science and society.
But while Serrano spends much of her time interacting directly with the community, she says most of her success is due to the relationships she’s built with community leaders.
“We work through community champions – the people these populations already trust,” she said. “It can take two years to build a relationship like that, but once we do, it’s invaluable.
“If a community finds, for example, the leadership of a certain church to be trustworthy, we’ll first share our message with those church leaders. Once we have someone advocating on our behalf, people become much more receptive to our message. That way we’re not just coming in off the street saying, ‘Give me your blood and saliva.’”
Christopher Sistrunk, Ph.D., an assistant professor at City of Hope, puts it more bluntly: “As a researcher, you can’t just walk into a building and show your credentials like a policeman and think you’re going to get anything you want,” he said. “But that’s how science treats communities in some cases.”
Instead, he says, you need to build trust by working through trusted organizations. Last month, for example, Sistrunk spoke to the congregation of an African-American church in Southern California. With the support of the pastor, he talked about the need to get regular prostate screenings.
Later, he will return to the church to personally escort the congregation to the clinic for a screening.
“It’s got to be an ongoing relationship,” Sistrunk said. “You can’t just parachute in and then leave.”
Reflecting the Community
Sistrunk, Chavez and Serrano agree that one of the keys to building trust is having a deep understanding of the communities you serve.
“Just going into the community and knowing that mistrust exists – and why it exists – is very helpful,” said Serrano. “By starting at a place of mutual understanding, you can begin to address their individual misgivings.”
Chavez agrees that understanding is a great starting point, but insists that an important element of success is having physicians and researchers that share a cultural background with the community they’re working with.
“You’ve got to diversify the people on the other side,” he said. “Researchers need to look like you. Take Mayra, for example. She was born in the area she serves, she speaks the language and she understands the culture.”
This, said Chavez, is especially important when it comes to addressing the issues that often accompany mistrust.
“It’s not just a lack of trust that are keeping people from getting screened,” he said. “You have to realize that health care isn’t the only thing these people are dealing with. There are housing, money and food issues that take precedence. Think about a woman who’s working two jobs and getting home at 11 o’clock at night. Getting a mammogram might be the furthest thing from her mind.”
Chavez said that it is important to see the “whole person,” not just a clinical need.
“Health isn’t just about your physical well-being,” he said. “It’s about thinking holistically. It’s thinking about the other ways people need help, then partnering with the community to provide for them.”
Going out into the community to encourage screenings is important, but Chavez points out that some services, like clinical trials, only take place on the City of Hope campus or at one of its community practice sites.
“It’s critical to enroll minorities in clinical trials,” he said. “If new medications and therapies are tested only in white male populations, we just won’t know how they will affect women or people of color.”
Serrano agrees: “Cancer care is increasingly about personalized medicine, where treatment varies from individual to individual,” she said. “We need to attract a wide variety of subjects if we hope to develop treatments for a wide variety people.”
In National Cancer Institute-funded trials between 2003 and 2005, African-Americans made up 8 percent of the study cohort, overshadowed by the nearly 90 percent of white enrollees.
Serrano, however, has had tremendous success in attracting diverse cohorts. In fact, she’s often called in to help other researchers recruit minority populations for their own studies.
“Since we’re culturally and linguistically diverse, we’ve never really had trouble recruiting into our studies,” she said. “We’ll even help others recruit when they don’t have the staff they need to be successful. In one example, we were able to increase minority participation by 244 percent.”
The Road Ahead
While dealing with entrenched disparities can seem overwhelming, City of Hope researchers seem to have hit upon a strategy that works. For his part, Chavez thinks that success starts with individual researchers.
“You need to adopt a commitment to cultural humility,” he said. “You need to make a lifelong pledge to address the imbalance of power within the physician-patient dynamic and on behalf of underserved populations.”
Serrano, with her years of experience, has learned another powerful truth:
“With most minority groups, success doesn’t lie with the individual,” Serrano said. “We can’t say that ‘This will benefit you, this will help you.’ That doesn’t sway them. What sways them is to say, ‘This is for your family.’ They’re interested in the future of their children. They want to know that this will benefit their community – that it’s for the greater good.”
Stories of Hope is a monthly series that explores important issues in health care. To commemorate National Minority Health Month, we are dedicating the entire month of April to health care disparities.
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