A student’s perspective:
The importance of family medicine research

By Allison Peddle

Presenting at the 19th WONCA International Conference of Family Doctors as a second-year medical student was a unique opportunity that I will never forget. My presentation was in the afternoon of a beautiful day in Cancun, Mexico at the same time as other insightful presentations, and I still had a packed room. I was honored to have so many people interested in my work. The number of questions after my presentation led to a delay in the rest of the presentations. This showed me the importance of my project and has inspired me to continue to do community-based participatory research in the future.

The summer after my first year at University of Texas Southwestern Medical Center, I was accepted into the Community Health Fellowship Program. The CHFP is a nine-week program in which first-year medical students learn the steps of community-based participatory research from getting approval from IRB to a final presentation and paper by doing their own project under the guidance of a mentor at UTSW and a community partner. My project was a health needs assessment of Hispanic seniors at a local community center.

In the United States, the Hispanic senior population is increasing at an alarming rate. This population is more likely to have a lower socioeconomic status, less education, limited health literacy and higher rates of chronic disease and depression when compared to younger age groups. The purpose of my project was to assess the health needs of Hispanic seniors attending Wesley-Rankin Community Center in Dallas, Texas. The specific aims included:

• Determining the prevalence of chronic disease and depression;
• Measuring quality of life and health literacy level;
• Determining whether there is an association between attendance and quality of life or health literacy and sociodemographic characteristics; and
• Determining curriculum needs for future health education programs.

We conducted a cross-sectional survey of Hispanic seniors enrolled in the senior citizen program at the Wesley-Rankin Community Center. A 25-item health needs assessment was administered to 52 Hispanic seniors through 15-minute face-to-face interviews. Frequencies and percents were used to report sociodemographic characteristics of this population. Chi square and Fischer exact tests were used to measure associations between categorical variables.

Out of 140 enrollees in the senior citizen program, we interviewed 52 seniors (40 percent response rate). Eligible participants were aged 60 years or older and enrolled in the senior citizen program. The mean age of the participants (86.54 percent female) was 75.8 years. A majority of participants (90.3 percent) had less than nine years of formal education and 42.3 percent of participants had an annual household income of less than $10,000. A majority of participants (77.9 percent) reported Medicare or public health insurance whereas 8.14 percent were uninsured. Over half of participants (61.5 percent) had limited-to-marginal health literacy.

The three most prevalent diagnosed conditions were hypertension (71.15 percent), arthritis (67.31 percent), and teeth problems (51.92 percent). Health literacy level was associated with transportation to doctor (p=0.013), attendance at Wesley-Rankin Community Center (p=0.0187), health care provider (p=0.048), and income (p=0.0075). Age was also associated with attendance (p=0.0028) and suggested activities (p=0.035).

Some of our conclusions could be generalized to the U.S. Hispanic senior population. General practitioners need to be aware of the high rate of limited to marginal health literacy when seeing Hispanic seniors and take precautions to make sure their patients understand their treatment. General practitioners should be aware of an association between health literacy and sociodemographic measures including: transportation to doctor, attendance, health care, and annual income. All Hispanic seniors should be screened for chronic disease such as hypertension, arthritis, dental problems, and depression when they come to a general practitioner. And finally, there is an association between attendance at a community center and health status.

Our specific recommendation to the Wesley-Rankin Community Center is that future health education programs for Hispanic seniors should focus on the top three reported health problems: hypertension, arthritis, and teeth problems. Also, the activities included in their senior citizen program should be age appropriate.

The unique opportunity to present my project at the 19th WONCA International Conference of Family Doctors was an amazing climax to my first community-based participatory research project. I met many general practitioners from all over the world who were inspiring to talk to. I met residents from England, a woman who works for the World Health Organization in Switzerland, and had a conversation in Spanish with a doctor from Colombia. I also learned about some research that is going on worldwide that will influence how we practice in the future, including some amazing work on decreasing the rate of abortions in Sao Paulo, Brazil.

Given the location of the conference in Cancun, Mexico, I also took some time to experience some sights. The group from UTSW went to Chitzen-Itza together one day, where we got to experience one of the new Seven Wonders of the World. We also enjoyed the beautiful white beach and blue water. The water was warm and so clear you could see the bottom. I celebrated daily with a real margarita and wonderful local cuisine; Mexican food in Texas will never meet my new standards.

Allison Peddle received a special travel grant from the TAFP Foundation to help fund her trip to WONCA.