Perspectives Archives - Education For Live

February 11, 2023

Impact of online learning on sense of belonging among first year clinical health students during COVID-19: student and academic perspectives | BMC Medical Education

Online student cross-sectional survey

Demographic characteristics

A total of 179 out of the possible 663 students (27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} completion) completed the online survey in June 2020. Median age of students was 19 years (IQR 18–28 years) and there were approximately three times as many females as males (Table 1), reflective of the undergraduate health sciences cohort (70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} female). Student numbers were also reflective of the broader enrolment numbers in the programs (i.e., occupational therapy is the largest program). Just over half (53{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}; n = 94) of students had no prior experience in undertaking a Bachelor degree, and 76{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students had not completed any online courses prior to enrolment.

Table 1 Demographic characteristics

Quantitative results to the sense of belonging questionnaire

In terms of students’ sense of belonging to the university, the majority felt ‘quite’ or ‘extremely’ happy with their choice of university (74{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and felt ‘quite’ or ‘extremely’ welcomed by the university (68{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}). While most students felt respected by both staff (70{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) and students (60{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) at the university, students reported less connectiveness (23.5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}) to the university. Only 20{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students reported they felt they were understood as an individual, and only 13{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} felt they ‘quite’ or ‘extremely’ mattered to others at the university (Table 2).

Table 2 Online learning and Sense of Belonging to the University [1]

Table 3 shows how the online learning experiences impacted on students’ perception of the course; 27{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students felt ‘quite’ or ‘extremely’ connected to staff while 16{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students felt ‘quite’ or ‘extremely’ connected to other students. While 49{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of students rated 4 and above for the level of respect that they received from other students and their contribution towards the subject, students who had prior higher education felt less respected than students who had no prior higher education (p = 0.03). When asked how the online subject had contributed to understanding, knowledge/skills in their chosen health profession, about half of the students rated the online subject highly (rating 4 and above). Students who had prior higher education indicated higher ratings of understanding and knowledge/skills compared to students without prior higher education (p = 0.07 and p = 0.03 respectively). There was also a significantly higher proportion of students with no prior higher education who identified the online learning experience as either ‘quite’ or ‘extremely’ likely to impact their intention to continue with their current course (p = 0.001).

Table 3 Impact of online profession-specific subject on perception of the course

Qualitative results

Qualitative findings provided insight into experiences of staff and students during the rapid, unplanned transition to online learning. Student questionnaire responses included two open-ended questions expanding on enablers and barriers to sense of belonging. These yielded 145 enablers and 254 barriers to students’ feeling a sense of belonging. Data were subjected to qualitative content analysis by two authors and categories are presented in Additional file 1.

Three focus groups were conducted: two student sessions, each with two students enrolled in Speech Pathology and Paramedicine, and one academic session with five participants. Four full time academics and one casual academic participated from a total population of nine eligible academics. Using the processes described in the methods, focus group analysis was compared with the survey content analysis and the authors identified synergies between them. Findings were then integrated under a global theme, underpinned by organising and basic themes. The following themes reflect triangulation between academic and student focus group data in addition to survey responses.

Global theme—navigating belonging during the COVID-19 crisis: a shared responsibility

“We are in this together…making the best of this”

This theme explores sense of belonging creation during this period as a shared process, where participants perceived they worked together to get through the crisis. Students and academics encountered many challenges as they transitioned to online learning but despite hard times, were able to engage positively. The global theme revealed students and academics were navigating belonging during the COVID-19 crisis, and this journey was a shared responsibility. Both groups were working to achieve positive student engagement that would in turn create a sense of belonging in first-year students. A strong commitment of working hard to make the best out of this was mutually acknowledged.

Students perceived academics had done “a really good job at making sure we belonged…in those first few weeks that we were on campus but even more so probably while we were in Zoom” (Student-Astrid-Focus Group). Academics perceived students were actively engaged in making online learning work and were collegial and collaborative.

The shared experiences about navigating belonging during the COVID-19 crisis, have been captured under four organising themes: dimensions of belonging, individual experiences and challenges, reconceptualising teaching and learning, and relationships are central to belonging. Within each organising theme, basic themes were identified that provide depth to the organising theme (Fig. 1). Additional files 1 and 2 present a summary of the quotes obtained from the open-ended surveys and focus groups respectively, that contribute to the themes in Fig. 1.

Organising theme: dimensions of belonging

This theme outlines that belonging is a multidimensional experience with several facets underpinning participants’ experiences. Students and academics identified several dimensions of belonging in relation to first year students’ experiences, as illustrated by two basic themes that sit under the organising theme: what it means to belong, and layers of belonging.

Basic theme: what it means to belong

This theme explores the idea that belonging at university is underpinned by feeling valued and connected. Academics and students agreed that having a sense of being valued by the university and a desire to have an active connection across all aspects of university life was important for students.

Belonging as a student was gained through a connection with the “vocation” (Student-Claire-Focus Group) or the course and career, and with people who will “be there” (Student-Claire-Focus Group) for them. Furthermore, support of academics was critical to gaining a sense of belonging. It was noted by academics and students, that when students feel they belong at university, they are actively engaged in their learning, and this sense of belonging in turn shapes their overall identity. Students can then “actually sort of relax and become themselves” (Staff-Brooke).

Belonging to their cohort, their course, their future profession, and their university was important for students. One academic noted that the “concept of acceptance” is part of the sense of belonging and goes “both ways” (Staff-Brooke).

Both academics and students agreed that the rapid change to online learning due to COVID-19, meant that developing a sense of belonging was challenged.

Basic theme: layers of belonging

This theme identified layers of belonging reflected in participants’ experiences. Peer, academic and professional layers each contributed to an overall sense of belonging and key examples are provided below.

Peers

Belonging to peers was described as “having that connection to someone that’s going through exactly the same thing as what you’re going through” (Student-Astrid-Focus Group). Students were concerned that when learning moved online that this sense of belonging would be jeopardised by less opportunities for in-person interaction.

Academics

Being connected to academics was perceived by students as directly impacting learning, with one student commenting: “…when they’re not connecting with the teacher, they’re not connecting with the content, they’re not connecting with the feedback. That’s when you develop this sense of feeling like you just don’t belong” (Student-Emily-Focus Group).

Academics perceived it was also important for students to develop a sense of belonging to the university community.

Profession

Belonging to a profession was identified as an important feature of belonging by academics and students. Studying a degree with a clear professional identity facilitated first year students to feel they belonged compared to those undertaking general health science degrees which may have multiple pathways and career options less directly aligned to first year studies.

One academic actively encouraged first year students to belong to their professional association as a way of fostering belonging in first years.

Organising theme—Individual experiences and challenges

This theme outlines that while there are similarities in participants’ experiences, individuals have unique contexts and factors shaping their experiences. Academics and students reflected upon personal impacts of the COVID-19 pandemic on their teaching or learning and how they responded as individuals to the ensuing challenges. Two basic themes emerged: Challenges of transition and recognising different learning preferences.

Basic
theme
—challenges of transition

This theme explored the significant challenges of transitioning to online teaching and learning. For some students, the transition to online learning offered potential benefits of flexibility and reduced travel time. Two of the four students in the focus groups opted for online learning opportunities available in other subjects of study prior to the pandemic to efficiently manage their study and external commitments. Nonetheless, the pandemic brought a raft of personal challenges that diminished these expected benefits. Covid-related changes to family employment, reduced access to childcare support and non-optional home schooling presented new concerns.

Clearly, students missed the opportunity to focus attention on their learning needs when balancing childcare demands and home-schooling during lockdowns.

Unlike a conventional online courses where students choose or plan to be online, the sudden, unexpected, and unplanned move to online study was prefaced by a short period (four weeks) of in-person class time. This initial in-person time was identified as being key to relationship building.

Academics identified positive experiences and challenges during the transition to online learning. The rapid change presented a problem to be solved and individuals could “embrace it and to work effectively…as a team” (Staff-Jane). Quickly strategizing and responding to the demands of online learning required team knowledge, experience, and support. Hence, enhanced team culture was a further positive for academics, being “present for each other” (Staff-Brooke).

Basic
theme
:
recognising different learning preferences

This theme identifies experiences of online learning influenced by personal attributes, individual expectations and learning preferences. Such key factors impacted students’ capacity to maintain focus on academic goals after the rapid change to online learning. Some students reflected that barriers were not solely a feature of online learning environments, reporting that competing priorities, including work commitments and limited contact time with staff as pre-existing challenges to belonging. However, some students directly attributed their limited engagement and reduced motivation to the online learning environment.

Students suggested that active engagement “comes down to personality” (Student-Astrid- Focus Group). If a student was not shy they were comfortable to come forward and participate online. Some students perceived clear links between personal discipline, engagement, commitment, and achievement in online learning environments.

Further, students perceived effective (and ineffective) online group functioning reflected personalities of individual members, with some groups/personalities seen as being able to organise whilst other groups lacked leadership and cohesion.

Students who perceived themselves as active engagers reported being drawn towards other students who demonstrated motivation to interact and learn. Other students perceived their personalities or learning preferences were misaligned with the expectations of belonging in online learning environments and focussed upon tasks rather than connection.

Academics recognised student diversity and a need to reflect and re-evaluate expectations of students in online environments. They accepted that some students may be quietly engaging and learning to belong, but this was harder to observe in online compared to in-person learning environments.

Organising theme—relationships are central to belonging

This theme identified the relationship between all parties as a fundamental aspect of creating a sense of belonging. Two basic themes were influential in shaping perceptions of how relationships and connections contribute to belonging: collaboration with peers is fundamental, and effective and regular communication with staff is necessary.

Basic
theme
—collaboration with peers is fundamental

This theme revealed collaboration with student peers was a key element of creating a sense of belonging. The degree of social interaction with student peers and opportunities to create friendships contributed to feelings of belonging. Accordingly, students found it problematic when peers neglected to turn cameras on during classes, making interaction very difficult. Visualisation of peers and use of cameras in online classes impacted students’ opportunities to get to know each other.

Challenges posed by online learning were further highlighted in the student survey through a focus on non-academic aspects of university and campus life. Typically, university campuses offer interactional opportunities through clubs, sport, and shared spaces to learn and socialise. Campus life, students suggested, may facilitate learning and personal development. Absence of this type of interaction was linked to barriers in developing friendships and consequently a lesser sense of belonging as reflected in Additional file 1.

Basic theme—
communication
with academics is necessary

This theme outlined that communicating with academics was a key component of creating a sense of belonging. With less opportunities for peer support, there was stronger reliance on the academic-student connection, although students reported positive and negative interactions with academics during online learning.

Positive interactions and individualised communication with academics enhanced student sense of satisfaction and belonging. Furthermore, students in the focus groups reported a feeling of trust and a bond created by a shared challenge. Survey responses echoed this sentiment, noting that academics were “non-judgmental and supportive” (Student Survey 18) and created a sense of camaraderie. However, when students perceived impersonal communication from academics, they felt less connected or believed that teaching had become a “transaction” (Student-Astrid- Focus Group). Perceived levels of enthusiasm and engagement from academics influenced student’s perceptions of connection and belonging.

Students identified the online environment as a barrier to communication with academics. While systematic and university level communication was perceived as a useful source of information, students prioritised individualised communication from academic staff as key to belonging.

Academics concurred that effective communication was challenged in online environments, missing non-verbal cues and responsivity that characterises a classroom environment. Although the online learning environment provides an opportunity for academics to connect professionally with students, there were students who left their cameras off, with one academic noting they didn’t push this issue because there are many reasons for students choosing this option.

Organising theme: reconceptualising teaching and learning

This theme reveals how academics and students reconceptualised their expectations and modes of teaching and learning, to manage the crisis. It was not easy for academics or students, and many strategies were employed to make it work, with two basic themes emerging: challenges to online teaching and learning, and strategies to engage and connect.

Basic theme:
challenges
of online teaching and learning: “how do I make this work?”

This theme outlined many challenges faced by both academics and students during a rapid change to online mode. With the rapid change to online learning, academics asked themselves, ‘How do I make this work?’.

Managing workload

Academics reported their workload increased significantly, and they “found it a juggling act” (Staff-Louise) to meet their teaching requirements. Administrative loads consequently increased when reduced in-person contact with students led to more electronic communication. Academics needed to up-skill in online teaching in a short time frame and perceived this responsibility as all encompassing.

The rapid switch to online learning attracted significant academic workload, implementing and adapting content to see how material “might play out in a Zoom environment…[where]…everything takes longer” (Staff-Natalie).

Some students noticed a temptation to disengage from online learning, which meant balancing their workload and study demands became a challenge as they also faced significant workload and stressors in their personal lives due to COVID-19.

Class dynamics

Academics and students spoke about the change to classroom dynamics. The online environment was noted as being one in which it was difficult to read the room to see how students were progressing with their work. Others tried to use humour to enliven a class, only to have the Zoom frame freeze, killing the mood they were trying to create. Hence, staff felt teaching online was less conversational, flexible and responsive compared to face-to-face. Moreover, academics missed hands-on practical elements; a big shift for some programs.

Technological challenges

Academics learnt new skills quickly, but often these skills would be challenged when technology failed. Some academics reported a sense of vulnerability due to technological ineptitude but acknowledged that making mistakes in front of students could humanise the experience. Academics also acknowledged that some students did not have adequate technological resources to meet changes in their learning requirements when classes were placed online.

Basic theme: strategies to engage and connect

This theme reflected the strategies academics and students employed to remain engaged and connected. Academics worked hard to enhance online learning and hoped to connect with students and engage them in activities. Students too were active and appreciated academics’ efforts to facilitate engagement and connection. Underlying many of the strategies adopted by academics was a deep concern for student welfare during this time. Therefore, many academics aimed to ensure students were engaged and connected with each other and with the academic team. Academics built in small group opportunities during online teaching so students could connect, learn, and socialise.

Staff also spoke about informing students they could contact staff for support. One staff member described crossing the divide and actively discouraging a ‘them and us’ dynamic between students and staff.

A variety of teaching tools were identified by staff to build connection and promote engagement. Such tools included interactive quizzes, ice breakers activities, integrating reflective practices into activities and ‘drop in’ sessions. Staff also encouraged students to establish social media groups or other group experiences outside the classroom. Some staff members arrived early to zoom classes and left late to enable students to connect informally.

Students appreciated staff attempts to provide these activities. Students found these initiatives helpful, recognising staff placed effort into knowing students personally and focussing on student wellbeing and achievement. Students cited examples of provision of extra resources, mini-lectures, additional question and answer sessions, and fast response times to student queries. Students also initiated their own engagement strategies, including using group and personal messaging over platforms such as Facebook messenger.

May 23, 2022

Perspectives From the National Institutes of Health on Multidimensional Mental Health Disparities Research: A Framework for Advancing the Field

There is ample research documenting the existence and persistence of mental health and mental health care disparities over the past several decades (1). For example, research consistently suggests that there are racial and ethnic differences in prevalence of some mental disorders (e.g., compared to non-Hispanic Whites, Blacks/African Americans have higher rates of diagnosed schizophrenia [2] and American Indians/Alaska Natives have higher rates of posttraumatic stress disorder [3]). Across diagnostic categories, racial and ethnic minority individuals have more severe and persistent impairment than non-Hispanic White individuals (4, 5). Similarly, compared to cisgender heterosexual individuals, sexual and gender minorities have higher rates of depression symptoms and suicidal behaviors (6). Despite efforts to address mental health and mental health care disparities, there remains a significant gap between our ability to document, investigate, and understand mental health disparities and their causes and to translate this research knowledge into interventions that meaningfully reduce disparities in clinical and health care outcomes.

The National Institute on Minority Health and Health Disparities (NIMHD) Health Disparities Research Framework (hereafter “the framework”) is intended to encourage a comprehensive approach to understanding and addressing health disparities with respect to race/ethnicity, socioeconomic status, sexual and gender minority status, and rural versus urban residence (7, 8). The framework, which is an extension of the socioecological model, consists of two dimensions: domains of influence on health (biological, behavioral, physical and built environment, sociocultural environment, health care system) that occur at different levels of influence on health (individual, interpersonal, community, societal). The individual cells of the framework each represent categories of potential determinants of health disparities and/or intervention targets to address health disparities.

Much of the focus in mental health disparities research, including research supported by the National Institutes of Health (NIH), has been either on single cells of the framework (e.g., individual-level biological determinants), single levels of influence (e.g., individual-level biological and behavioral determinants), or single domains of influence (e.g., lack of access to mental health care as the primary driver of disparities). However, this approach does not take into account the complex interaction of structural and social determinants of mental health that create mental health disparities. Thus, addressing mental health disparities requires research that explores factors at multiple levels of influence, particularly beyond the individual level. Such research should prioritize an understanding of how community, social, and structural factors, including structural racism and discrimination, impact individual-, community-, and population-level mental health outcomes. In addition, research that examines how domains and levels of influence interact across multiple levels (i.e., cell×cell interactions) is necessary to better approximate the real-world complexities of how interconnected determinants impact the mental health of individuals, families, communities, and populations.

To encourage mental health disparities research that uses a multidimensional approach and to provide researchers with a more tailored approach than other existing disparities frameworks and models, we offer an adaptation of the framework specific to mental health disparities (Figure 1). The examples provided within the cells of the framework are intended to be illustrative rather than exhaustive. This adapted framework is similar to other frameworks and models that describe social determinants of health (SDOH), such as those by the U.S. Department of Health and Human Services Healthy People 2030 (9) or the World Health Organization (10). What distinguishes this framework is that it includes both general SDOH and determinants that may be specific to mental health to promote a more comprehensive view of mental health disparities. In addition, the adapted framework emphasizes the simultaneous examination of both domains and levels of influence to provide an organizational structure with which to identify or conceptualize relevant determinants and generate appropriate strategies to address them.

**FIGURE 1. An adaptation of the National Institute on Minority Health and Health Disparities Research Framework for mental health disparities**

As a hypothetical example, suppose researchers and community partners wish to develop an intervention to improve help-seeking to address high rates of depression and posttraumatic stress disorder in a local Hmong population. The team views health literacy as the key feature driving low levels of help-seeking, but they also identify other relevant determinants, including lack of health insurance, food insecurity, lack of transportation, and lack of availability of Hmong-speaking providers. It becomes clear to the team that a health information–focused intervention alone is unlikely to result in improved help-seeking unless these structural barriers to accessing mental health care are also addressed. We are not suggesting that determinants in all cells of the framework must always be included to address health disparities, but we highlight the importance of examining the constellation of determinants relevant to the specific disparities being studied, and the need to intervene at the appropriate levels to have a sustained impact. The availability of a framework that emphasizes multidomain, multilevel determinants of health does not ensure that research approaches and interventions will successfully address mental health disparities—this depends upon how researchers and stakeholders apply and implement the framework.

Based on the concept of generations of health disparities research (11), we describe examples of three types of mental health disparities research in which the adapted framework may be implemented and that address SDOH. Note that research to document mental health disparities is not included here if does not also examine mechanisms or determinants of those disparities, or if SDOH are measured but included only as control variables in analyses. Although this research progression may be a natural evolution, we argue that the highly incremental research that has characterized much of the health disparities field is not necessary to replicate for mental health disparities, given that this foundational work is often relevant across health conditions and outcomes.

First Generation: Understanding How SDOH Cause, Sustain, or Mitigate Mental Health Disparities

This body of research moves beyond individual-level determinants of mental health disparities (e.g., lack of awareness of mental health problems, lack of health insurance) to identify higher-level social and structural factors that contribute to or mitigate health disparities. Factors such as family and community cohesion, population density, neighborhood-level disadvantage, neighborhood safety and community violence, community social climate, and community and national-level racism and discrimination have all been found to be associated with individual and community-level mental health symptoms and distress (12). This work is critical in identifying modifiable intervention targets that have potential to reduce mental health disparities. Because the social and policy landscape is constantly changing with respect to impacts on minoritized and marginalized populations, this work will always be needed. However, the current distribution, where most mental health disparities research reflects observational research to document and understand disparities, needs to be shifted more toward intervention and action. For example, a recent portfolio analysis conducted by the NIH Office of Disease Prevention of new NIH-funded extramural projects from fiscal year 2012 to 2019 (13) found that about two-thirds of prevention projects were observational, while randomized intervention studies accounted for less than one-fifth of projects, and this proportion declined over time. In addition, only 3.5{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of prevention projects included a randomized intervention to address a leading risk factor for death and disability in populations experiencing health disparities. Prevention research specific to mental health outcomes accounted for less than 8{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of projects in fiscal year 2019 and mirrored these overall patterns (13).

Second Generation: Evaluating Interventions That Help Individuals Address SDOH or Mitigate Their Impact

This body of research recognizes that the unique experiences of minoritized and marginalized populations need to be acknowledged and addressed in the context of mental health interventions and care. Examples include 1) coping-focused interventions to help individuals manage or reduce distress associated with racism or other forms of discrimination, poverty, unemployment, family separations, and other challenging life circumstances (14, 15); 2) trauma-informed interventions that tailor services for individuals exposed to early or chronic traumatic events or poverty-related stressors (16–18); and 3) patient navigation or service linkage interventions that connect individuals to needed health and social services and/or address access barriers to facilitate engagement in care (19, 20). Such interventions, although a critical component of health and mental health care, only address the consequences of societal inequities and do not directly affect the systems and structures that cause and sustain mental health disparities. In isolation, these interventions will not be sufficient to reduce or eliminate mental disparities at the population level. However, based on our observation of applications submitted to NIH, interventions to help individuals or populations mitigate the impact of SDOH rather than changing the SDOH directly remain common.

Third Generation: Evaluating Interventions That Directly Impact SDOH to Produce Lasting Changes for Communities and Populations

Notably, this area seems to be characterized by more articles calling for social and structural interventions (21, 22) than articles describing the results from actual social and structural interventions (23), and the latter are particularly rare in the mental health field. To address mental health disparities, interventions must move beyond an individual-level treatment-focused model of mental health to emphasize families, organizations, and communities and encompass prevention and sustainable change. Examples of such interventions include medical-legal partnerships in which clinicians and legal personnel work to address discrimination or unfair practices related to housing, education, criminal justice, or other domains (24); alternatives to incarceration for individuals with severe mental illness charged with minor offenses (25); and the implementation of evidence-based depression treatment in faith-based settings (26). However, many structural interventions addressing SDOH have not been rigorously evaluated, and few studies have examined the impact of interventions on disparities (21). Although critically needed, research evaluating these types of interventions has many challenges. Balancing methodological rigor with feasibility and acceptability of study designs can be an issue that requires thoughtful communication and collaboration between research and community collaborators. Studies can be costly to execute, as testing interventions at organizational, neighborhood, or community levels requires these settings to be the unit of analysis rather than the individual, necessitating the inclusion of multiple sites or locations. Interventions addressing SDOH (e.g., racism and discrimination) are likely to have nonspecific outcomes relevant to a range of health conditions, which may pose a challenge to funders who prefer interventions to address disease-specific determinants of health leading to disease-specific outcomes. Despite these many challenges, such interventions hold the greatest promise for eliminating mental health disparities and achieving mental health equity.

On an encouraging note, NIH is beginning to emphasize the need for interventions that move beyond addressing SDOH at the individual level in recent funding opportunity announcements. Topics have included maternal mortality and morbidity (27), structural racism and discrimination (28), family- and community-level interventions (29, 30), physical activity (31), opioid misuse (32), HIV (33), firearm morbidity and mortality (34), and suicide and suicidal ideation and behaviors (35). Although these funding opportunities may include mental health determinants and outcomes, additional targeted opportunities from NIH and other funders of mental health research and services that are explicitly focused on SDOH and mental health disparities are likely needed to make significant progress in this area.

Taken together, this review suggests several important implications for mental health disparities research and clinical practices aimed at reducing disparities. First, this review highlights the opportunity for researchers to use and build upon the proffered mental health disparities framework to mechanistically explore SDOH that can subsequently inform appropriately framed and tailored interventions to reduce disparities. Second, from a clinical perspective, this review points to the importance of establishing a continuum of care to address mental health disparities, which includes both mental health promotion and prevention interventions among marginalized and minoritized populations. Development of interventions aimed at the promotion and prevention end of the mental health continuum of care would facilitate addressing the social and structural factors that have been identified as significant drivers of mental health disparities, including SDOH, and would increase the ultimate reach and range of intervention.

Office of Disease Prevention, NIH, Bethesda, Md. (Alvidrez); Office for Disparities Research and Workforce Diversity, NIMH, Bethesda, Md. (Barksdale); National Institute on Minority Health and Health Disparities, NIH, Bethesda, Md. (Barksdale).

The views expressed in this article represent those of the authors and do not necessarily represent the views of NIH.

The authors report no financial relationships with commercial interests.

References

1. US Department of Health and Human Services: Publications and Reports of the Surgeon General, in Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville, Md, Substance Abuse and Mental Health Services Administration, 2001Google Scholar

2. Gara MA, Vega WA, Arndt S, et al.: Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry 2012; 69:593–600Crossref, Medline, Google Scholar

3. Gone JP, Trimble JE: American Indian and Alaska Native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol 2012; 8:131–160Crossref, Medline, Google Scholar

4. Vilsaint CL, NeMoyer A, Fillbrunn M, et al.: Racial/ethnic differences in 12-month prevalence and persistence of mood, anxiety, and substance use disorders: variation by nativity and socioeconomic status. Compr Psychiatry 2019; 89:52–60Crossref, Medline, Google Scholar

5. Breslau J, Kendler KS, Su M, et al.: Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 2005; 35:317–327Crossref, Medline, Google Scholar

6. King M, Semlyen J, Tai SS, et al.: A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry 2008; 8:70Crossref, Medline, Google Scholar

7. Alvidrez J, Castille D, Laude-Sharp M, et al.: The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health 2019; 109:S16–S20Crossref, Medline, Google Scholar

8. National Institute on Minority Health and Health Disparities: NIMHD Research Framework. 2017. nimhd.nih.gov/researchFrameworkGoogle Scholar

9. Healthy People 2030, US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. health.gov/healthypeople/objectives-and-data/social-determinants-healthGoogle Scholar

10. World Health Organization: Social determinants of health: overview. www.who.int/health-topics/social-determinants-of-health#tab=tab_1Google Scholar

11. Thomas SB, Quinn SC, Butler J, et al.: Toward a fourth generation of disparities research to achieve health equity. Annu Rev Public Health 2011; 32:399–416Crossref, Medline, Google Scholar

12. Alegría M, NeMoyer A, Falgàs Bagué I, et al.: Social determinants of mental health: where we are and where we need to go. Curr Psychiatry Rep 2018; 20:95Crossref, Medline, Google Scholar

13. Murray DM, Ganoza LF, Vargas AJ, et al.: New NIH primary and secondary prevention research during 2012–2019. Am J Prev Med 2021; 60:e261–e268Crossref, Medline, Google Scholar

14. Miller MJ, Keum BT, Thai CJ, et al.: Practice recommendations for addressing racism: a content analysis of the counseling psychology literature. J Couns Psychol 2018; 65:669–680Crossref, Medline, Google Scholar

15. Woods-Giscombé CL, Gaylord SA: The cultural relevance of mindfulness meditation as a health intervention for African Americans: implications for reducing stress-related health disparities. J Holist Nurs 2014; 32:147–160Crossref, Medline, Google Scholar

16. Meléndez Guevara AM, Lindstrom Johnson S, Elam K, et al.: Culturally responsive trauma-informed services: a multilevel perspective from practitioners serving Latinx children and families. Community Ment Health J 2021; 57:325–339Crossref, Medline, Google Scholar

17. Stolbach BC, Anam S: Racial and ethnic health disparities and trauma-informed care for children exposed to community violence. Pediatr Ann 2017; 46:e377–e381Crossref, Medline, Google Scholar

18. Brotman LM, Dawson-McClure S, Kamboukos D, et al.: Effects of ParentCorps in prekindergarten on child mental health and academic performance: follow-up of a randomized clinical trial through 8 years of age. JAMA Pediatr 2016; 170:1149–1155Crossref, Medline, Google Scholar

19. Barnett ML, Gonzalez A, Miranda J, et al.: Mobilizing community health workers to address mental health disparities for underserved populations: a systematic review. Adm Policy Ment Health 2018; 45:195–211Crossref, Medline, Google Scholar

20. Bridges AJ, Andrews AR III, Villalobos BT, et al.: Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. J Lat Psychol 2014; 2:37–53Crossref, Medline, Google Scholar

21. Brown AF, Ma GX, Miranda J, et al.: Structural interventions to reduce and eliminate health disparities. Am J Public Health 2019; 109:S72–S78Crossref, Medline, Google Scholar

22. Shim RS, Compton MT: Addressing the social determinants of mental health: if not now, when? If not us, who? Psychiatr Serv 2018; 69:844–846Link, Google Scholar

23. Thornton RL, Glover CM, Cené CW, et al.: Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Aff (Millwood) 2016; 35:1416–1423Crossref, Medline, Google Scholar

24. Paul EG, Curran M, Tobin Tyler E: The medical-legal partnership approach to teaching social determinants of health and structural competency in residency programs. Acad Med 2017; 92:292–298Crossref, Medline, Google Scholar

25. Castillo EG, Ijadi-Maghsoodi R, Shadravan S, et al.: Community interventions to promote mental health and social equity. Curr Psychiatry Rep 2019; 21:35Crossref, Medline, Google Scholar

26. Hankerson SH, Wells K, Sullivan MA, et al.: Partnering with African American churches to create a community coalition for mental health. Ethn Dis 2018; 28:467–474Crossref, Medline, Google Scholar

27. National Institutes of Health: RFA-MD-20-008, Addressing Racial Disparities in Maternal Mortality and Morbidity (R01 Clinical Trial Optional). 2020. grants.nih.gov/grants/guide/rfa-files/RFA-MD-20-008.htmlGoogle Scholar

28. National Institutes of Health: RFA-MD-21-004, Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01 Clinical Trial Optional). 2021. grants.nih.gov/grants/guide/rfa-files/rfa-md-21-004.htmlGoogle Scholar

29. National Institutes of Health: PAR-21-358, Risk and Protective Factors of Family Health and Family Level Interventions (R01 Clinical Trial Optional). 2021. grants.nih.gov/grants/guide/pa-files/PAR-21-358.htmlGoogle Scholar

30. National Institutes of Health: RFA-MD-22-007, Community Level Interventions to Improve Minority Health and Reduce Health Disparities (R01 Clinical Trial Optional). 2022. grants.nih.gov/grants/guide/rfa-files/RFA-MD-22-007.htmlGoogle Scholar

31. National Institutes of Health: NOT-OD-21-087, Notice of Special Interest (NOSI): Developing and Testing Multilevel Physical Activity Interventions to Improve Health and Well-Being. 2021. grants.nih.gov/grants/guide/notice-files/NOT-OD-21-087.htmlGoogle Scholar

32. National Institutes of Health: RFA-DA-22-036, NIH HEAL Initiative: Preventing Opioid Misuse and Co-Occurring Conditions by Intervening on Social Determinants (R01 Clinical Trials Optional). 2021. grants.nih.gov/grants/guide/rfa-files/RFA-DA-22-036.htmlGoogle Scholar

33. National Institutes of Health: NOT-MD-21-014, Notice of Special Interest (NOSI): Multi-Level HIV Prevention Interventions for Individuals at the Highest Risk of HIV Infection. 2021. grants.nih.gov/grants/guide/notice-files/NOT-MD-21-014.htmlGoogle Scholar

34. National Institutes of Health: NOT-OD-21-059, Notice of Intent to Publish Funding Opportunity Announcements for Research on Firearm Injury and Mortality Prevention. 2022. grants.nih.gov/grants/guide/notice-files/NOT-OD-21-059.htmlGoogle Scholar

35. National Institutes of Health: RFA-MH-21-187, Systems-Level Risk Detection and Interventions to Reduce Suicide, Ideation, and Behaviors in Youth From Underserved Populations (R01 Clinical Trial Optional). 2021. grants.nih.gov/grants/guide/rfa-files/RFA-MH-21-187.htmlGoogle Scholar

Posted on March 30, 2022
Monadnock Ledger-Transcript – Monadnock Perspectives: Cooperation was key to Mason Elementary School getting through COVID

In the summertime of 2020, Mason Elementary University Superintendent/Principal Kristen Kivela was making an attempt to arrive up with a strategy to bring college students again to university that fall, with some help from fifth-grade teacher Alexcina Leel.

“We just used the whole summer brainstorming, ‘How do we make this get the job done?’” Kivela said.

Collectively, they came up with the hybrid design the college released when the initially college students, in kindergarten and 1st quality, came back that October. Students in 2nd and 3rd quality returned that November, and fourth and fifth quality appropriate prior to Xmas.

They returned to a hybrid product in which they have been in faculty two days a week and distant the other 3. The faculty utilized a team-teaching model where kindergarten and initial quality teachers have been with each other, as have been 2nd and 3rd and fourth and fifth grades.

One would educate a subject to college students in the classroom whilst the other taught a various class to college students at residence, and then they would change.

“Every kid was receiving the exact total of instruction in the course of the working day from teachers,” Kivela said. “We weren’t losing educational time. We had been just supplying it a distinctive way.”

According to 1st-quality trainer Karen Mann, “As a trainer, just about anything would have been improved than instructing remote.”

The faculty shut down in March 2020, and learners ended up despatched residence with Chromebooks and packets, which parents would trade for new types.

“It was pretty a lot father or mother-driven instruction,” Kivela stated. “At that place, it was ‘Get by it.’”

Mann reported the experience was not as horrific as in other spots mainly because of involved and supportive mom and dad, but there were issues this kind of as training looking at, explaining that the full premise is placing sounds collectively, and of 14 or 15 screens, 50 percent could not hear.

“It was hard to discern who was having it and who wasn’t acquiring it,” she explained.

Now that all the learners are back again, Mann claimed academics have been steady, except for having difficulties students, but there is additional insecurity if schedules transform or if anyone is absent.

“Everybody has variety of had to reassure each individual other that everything’s going to be Okay,” she mentioned. “There’s just sort of enhanced anxiousness.”

Mann’s class begins with a course assembly, typically with some type of individual query.

“A whole lot of the stress arrives out through that time,” she claimed. “It form of gives us a opportunity to get that variety of stuff out.”

Mitigation actions

The faculty has absent back and forth on mask mandates prior to lifting them in early March. Originally, the faculty required masks if 10 learners caught COVID, but with somewhere around 80 learners in the college, that was far too numerous, so it was slice to 1.

Pupils experienced to keep 6 feet apart in every single quality besides to start with, the place the necessity was 3 ft. If students were being 6 feet aside, they did not have to dress in masks.

Pupils are however feeding on lunch in their lecture rooms due to the fact social distancing is not feasible, but Kivela said she hopes the cafeteria will be back again in use this spring.

Just one adjustment Mann had to make was utilizing desks, because in additional than 20 a long time of teaching, she had never experienced them. Nonetheless, she mentioned the students were fantastic about sitting in their desks. They had been also fantastic about masks.

“Young young children, they will increase to whatever you ask them to do,” she said. “They want to be sure to, and they want to be joyful in university.”

It was not just Mann’s class that necessary to insert desks when college students had been forced to sit in socially distanced rows.

“I had to waste so substantially revenue on desks,” Kivela mentioned. “Now I don’t know what I’m likely to do with the desks.”

The college also received tests from the point out, meaning it could take a look at college students appropriate there as an alternative of acquiring to wait around for mothers and fathers to acquire them to the physician.

“That was a recreation-changer,” Kivela stated.

Kivela and Mann agreed that the vibe was unique after the mask mandate was lifted.

“They’re so a great deal happier. You can see their minor faces and their small smiles,” Mann stated, including that it is also a lot easier to listen to children discuss.

Kivela said the team is virtually 100{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} vaccinated, and concerning the selection of students who have been vaccinated or had COVID, immunity degrees are higher.

“I think we’re in a great area,” she reported.

Kivela said she discovered the significance of obtaining the believe in of the local community, mother and father and workers, and mentioned she instructed moms and dads and team that she would not have required to go by way of a pandemic any place else.

“The mothers and fathers could not have liked it, but they were eager to do it,” she mentioned. “They were being completely on our side. They reliable our recommendations, and they have been behind us 100{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf}.”