Nguyen-Truong CKY, Spence SR, Leung J, Geil S. Creative community and academic collaboration approach in the development of the Micronesian early education toolkit for easing access into early childhood learning through an experiential process of improvement. HPHR. 2022;54. 10.54111/0001/BBB7
The Micronesian and Pacific Islander community experiences adverse childhood experiences (ACEs) at rates higher than other ethnic groups. Exposure to ACEs increases the risk of negative outcomes, including heart disease, cancer, and psychosocial problems into adulthood. Early childhood learning (ECL) provides resilience against ACEs. However, Micronesian and Pacific Islander children reportedly have 53.8% not enrolled in ECL.
The purpose is to describe a creative community and academic collaboration approach, including culturally responsive partnership building exercises with inspirational reflections as a communication process between partners in the Micronesian Islander Community non-profit organization and Washington State University College of Nursing that led to the development of a culturally responsive, web-based, Micronesian Early Education Toolkit with Micronesian Islander Parent Leader Champions. We engaged a local school district to participate. Tenets of Popular Education guided partnership building. The Early Childhood Education Access Framework guided toolkit development and experiential improvement process. The toolkit includes both text and videos on what is ECL and importance, ECL program types, and navigation of the application process. We used a Plus/Delta evaluation.
Nine Parent Leader Champions representing Chamarro, Chuukese, Kapingamarangi, Marshallese, and Pohnpeian communities reported that the toolkit respects cultural values; easy to comprehend and navigate; the process makes it feasible to help enroll Micronesian Islander preschool students; and will be helpful at expanding access to ECL programs.
The toolkit development and experiential improvement process centered the voice of Micronesian Islander Parent Leader Champions. This helped the toolkit to be interactive, clear with specific utility for diverse English-speaking levels, respectful language, and creativity on how families can start.
This creative community and academic collaboration approach, including Micronesian Islander Parent Leader Champions and engaging a local school district achieved development of a culturally responsive ECL toolkit that was a helpful foundation to begin ECL enrollment.
Adverse childhood experiences (ACEs) are traumatic events including psychological, physical, or sexual abuse; witnessing violence against a parent – especially the mother; living with persons who abuse substances; and living with persons who have mental illness, suicidality, or criminal behavior in the household.1 Exposure to ACEs increases risk for a variety of adverse health outcomes and psychosocial problems into adulthood. Pacific Islanders, including the often invisible Micronesian Islanders (MI), experience ACEs at rates higher than other ethnic groups.2 Physical and mental health, influenced by socioeconomic and cultural factors, are woven in the health of an individual.3 Lower socioeconomic position during childhood is associated with higher rates of exposure to ACEs.3 In the United States Pacific Northwest, the Pacific Islander community has higher rates of children under five years old living in poverty than other racial groups.4 In 2018, the Board on Children, Youth, and Families of the National Academies of Sciences, Engineering, and Medicine underscored the importance of financing early childhood learning (ECL; pre-school/pre-kindergarten).5
Resilience can be defined as the development of skills or processes that allow children to adapt to significant trauma.6 Resilience is multifactorial, comprised of both internal factors such as personality traits and external factors such as community support and environmental resources. The support and resources are protective and can be provided by ECL programs as means to offset the adversity experienced with ACEs.7,8 For example, one study found that three- and four-year-old children who were enrolled in Head Start had made significant gains in school readiness, cognitive skills, and socioemotional learning.9 However, nationally, 53.8% of Pacific Islander children aged three to five years are not enrolled in ECL.10 About 51.8% of children aged three to four years are not enrolled in ECL in Oregon state of the United States Pacific Northwest.11 The Micronesian and Pacific Islander community is a historically underserved community in Oregon.4 The Executive Director of the MI-based non-profit community organization reported there was only one Micronesian child enrolled in Head Start, an ECL program, in Oregon’s Early Learning Hub of Marion and Polk counties during the 2019-2020 school year. Despite available ECL programs, barriers often prevent navigating these resources. In our prior community-based participatory research study, parents identified the difficulty in navigating the school system, the ability to interact with teachers, and struggle in completing required forms.12 This is an inequity in protecting against adverse physical and psychological health problems and outcomes.
There are important contextual considerations when engaging with the MI community in developing a solution to address a problem. A cultural difference exists surrounding education. While many from the MI community describe education as compulsory on their home islands, attendance was not enforced or actively encouraged.13 Family obligations often take priority. Parents and children are often unfamiliar with American school culture.14 Members of the MI community describe a difference between United States and MI culture in general. They often describe MI culture as tight knit and community-centric where family is the core unit, but problems and solutions are often shared across the community forms.12 Engaging community leaders, spending time to build trust and rapport, and honoring cultural context are best practices in working with Micronesian and Pacific Islanders for community-based projects.12,15,16,17,18 Furthermore, tenets of community-based participatory project include mutual learning and capacity building among community and academic partners; promoting empowerment and voice in shared decision-making; and building on the community’s strengths and resources.18
Details of the formation and expansion of the partnership between the Micronesian Islander Community non-profit organization and public Washington State University College of Nursing were previously described elsewhere through the Health and Education Program.15,17,19 There is evidence to support development of an ECL toolkit. Research has shown that awareness and information campaigns that publicize the benefits, costs, and registration procedures for ECL can be useful in creating confidence in those leading efforts in programs among low-income, immigrant families.20 Other studies have found that the vast majority of low-income, immigrant families use social connections when finding their first ECL opportunity.21 Social support and integration can also be effective in assisting families with navigating the registration process.21,22 The purpose of this article is to describe a creative community and academic collaboration approach, including culturally responsive partnership building exercises with inspirational reflections as a communication process between partners in the Micronesian Islander Community non-profit organization and Washington State University College of Nursing that led to the development of a culturally responsive, web-based, Micronesian Early Education Toolkit with Micronesian Islander Parent Leader Champions (hereafter referred to as PLCs). Our process goals for the toolkit were: 1) To develop an ECL toolkit that will increase PLCs understanding of available resources and ECL programs, and 2) To develop an ECL toolkit with PLCs that can be easily used by PLCs to engage and inform MI community members in enrolling in ECL programs. We developed the Micronesian Early Education Toolkit with PLCs through an experiential process of improvement and evaluated the toolkit for strengths, utility, and improvements. We engaged the local Salem-Keizer school district to participate.
The project (#18011-001) was determined exempt by the Washington State University Human Research Protection Program in addition to the Washington State University College of Nursing ethical internal review committee approval. The project was held virtually with 100% social distancing during the COVID-19 pandemic. We conducted a separate different project purpose that examined use of a distance learning format and that report was in review at the time of this article submission. For the purpose of this article, we described the following. Due to the COVID-19 pandemic health context, 2 PLCs, of which 1 PLC, were unable to attend the first and third session respectively of the total of 4 video face-to-face group sessions. The health context involved needing to take care of a family member and/or taking care of self with COVID-19. All PLCs received the session contents. One older participant initially needed assistance in the following ways: an older grandchild connected to a video platform, the Executive Director of the Micronesian Islander Community Organization assisted to turn on and off the microphone to address background sound, and an academic nurse partner with a Vietnamese American and Guamanian MI background assisted the older PLC and answered questions and reviewed the session content after each session. PLCs received a $25 shopping gift card and a meal per video session for a total of 4 sessions and an additional $50 shopping gift card as a thank you and a certificate in recognition of their leadership participation upon completion.
The community partners included the Executive Director of the Micronesian Islander Community organization and PLCs who facilitated a one-hour participatory group discussion session on grounding collaboration agreements. This is essential to do as this honors the space in how we want to work and learn collaboratively as community and academic partners. Nine PLC volunteers co-led the creation of the grounding agreements and named as the Island Basket of Agreements. PLCs identified as Chamarro, Chuukese, Kapingamarangi, Marshallese, and Pohnpeian who lived in and around Salem, Oregon. A staff member at the Micronesian Islander Community organization voluntary participated in the video sessions 1 and 2. PLCs identified parenting/caregiving roles as being a grandparent, mother, and/or aunt. We discussed and agreed upon the Island Basket of Agreements as partners (Box 1).
Box 1. Grounding collaboration agreements as the Island Basket of Agreements
· Micronesian Islander Community organization will send a reminder email about the sessions is helpful
· Respect time and be on time
· Be open, ask questions, answer when someone is asking questions, and be alert
· Respect one another’s experiences
· Respect the care that we do for our children and ask questions if want to know more
· Step up and step back – for example, if you ask questions all day, then need to step back and in another example, on video call, some people may talk more on Zoom than others, some people may be quiet, and to have courage to speak
· No judging/ not judgmental
· Take care of self
Popular education is founded on the notion that the distribution of power is unjust between the partners and that change is needed to address that inequity.23 We used tenets of popular education, also known as empowerment, to guide our creative collaboration communication process through culturally responsive partnership building exercises with reflections (Box 2).15,19,23 This facilitates communication engagement in building a sustainable partnership dynamic and the culturally responsive interactions among community and academic partners.
Box 2. Tenets of Popular Education15,19,23
· Learn with heads (cognitive), hearts (affective), and bodies (psychomotor)
· Create an atmosphere of trust is important to foster sharing of ideas and experiences
· Every person knows a great deal and people should always start with what they know
· Knowledge from life experience is equal to that acquired through formal education
· Knowledge develops through interactions among people
· People are active in their own learning process
Sources: 15. 1Nguyen-Truong CKY, 1Leung J, Micky K, Nevers JI. Building safe didactic dialogues for action model: mobilizing community with Micronesian Islanders. Asian Pac Isl Nurs J. 2020;5(1):1-11. PMID: 32704525 doi:10.31372/20200501.1066 [1Co-first authors] 19. Spence SR, Leung J, Geil S, Nguyen-Truong CKY. Gaining entrée into a Micronesian Islander-based community organization through culturally responsive team building and reflection. Asian Pac Isl Nurs J. 2020;5(3):177-180. PMID: 33324737 doi:10.31372/20200503.1099 23. Wiggins S. (2012). Popular education for health promotion and community empowerment: a review of the literature. Health Promot Int. 2012;27(3):356-371. PMID: 21835843 doi:10.1093/heapro/dar046
An academic nurse partner included one Vietnamese American with a Guamanian MI and community-based participatory research background and two academic nurse partners in family practice and psychiatric mental health practice who mindfully, verbally recognized the privileges of their White background. Partners engaged in culturally safe dialogues centered on uplifting PLCs with cultural humility centered on mutual learning. An academic nurse partner in family practice led the creation of intentional culturally responsive partnership building exercises with inspirational reflections applicable to work activities to build trust and cultural understanding first within the Micronesian Islander Community organization and academic project team of partners during the six main planning stage sessions (details reported elsewhere).19 Then building upon that planning stage, there were culturally responsive partnership building exercises with inspirational reflections with PLCs during the process development implementation stage and dissemination stage, eight and two sessions respectively (Table 1).
Table 1. Culturally responsive partnership building exercises at the opening of each session with closing inspirational reflections at the end of each session
Culturally responsive partnership building exercises at the opening of each session
Closing reflections through readings of inspirational quotesa – applicable to work activities at the end of each session
Discuss something each partner enjoys but has not been asked about recently.
-Time needed for exercise:
To build project team of partners engagement and establish a safe place by sharing personal experiences.
“Instead of trying to build a brick wall, lay a brick everyday. Eventually you’ll look up and you’ll have a brick wall.” Nipsey Hussle
Describe a favorite activity completed by each partner in the last month.
-Time needed for exercise:
To further develop the atmosphere of open sharing and communication.
“Coming together is a beginning, staying together is progress, and working together is success.” Henry Ford
This or that: Discussed a choice between two selections and why each partner made that choice.
-Time needed for exercise:
To facilitate understanding of individual variations in values and beliefs.
“The way we reflect the world around us is the direct reflection of the world within us.” Gabrielle Bernstein
Each partner provided a compliment to every other partner. Partners then had to give themselves a compliment as well.
-Time needed for exercise:
To promote positive, uplifting dialogue and provide recognition. Additionally, to help partners with identifying and appreciating their own strengths.
“Life’s most persistent and urgent question is: What are you doing for others?” Martin Luther King, Jr.
Each partner shared a favorite childhood food that provoked an emotion or special memory.
-Time needed for exercise:
To build appreciation for each other’s individual experiences and understand the emotional connection people have to specific experiences/memories.
“Find a group of people who challenge and inspire you, spend a lot of time with them, and it will change your life forever.” Amy Poehler
Each partner shared a hobby they have enjoyed during the COVID pandemic.
-Time needed for exercise:
To facilitate community-building through shared experiences during a difficult time.
“Decisions are made by those who show up.” Aaron Sorkin
Each partner shared a family game or activity that they enjoy and/or had fond memories of.
-Time needed for exercise:
To advance community building through understanding of each other’s family culture and influences.
“Community is much more than belonging to something; it’s about doing something together that makes belonging matter.” Brian Solis
Each partner shared a talent that the group did not already know about them.
-Time needed for exercise:
To facilitate understanding and appreciation of individual differences.
Viewed video poem performance of “The Republic Rising: A Tribute to the Empire State Building” by Amanda Gorman.
Each partner shared whether or not they had completed specific activities in, Never Have I Ever
-Time needed for exercise:
To advance collaboration through recognition of both shared and unique experiences.
“Only those who risk going too far can possibly find out how far one can go.” T.S. Elliot
Each partner shared about a person who has had a meaningful impact on their life.
-Time needed for exercise:
To advance understanding and collaboration through appreciation of each other’s personal experiences and beliefs.
“Life’s most persistent and urgent question is: What are you doing for others?” Martin Luther King, Jr.
Note. aThe inspirational quotes are from thought leaders and artists known throughout history. The inspirational quotes were chosen based on their meaningful applicability to the work being completed.
We used a modified Early Childhood Education Access Framework by Archambault and colleauges24 that guided the development of the culturally responsive, web-based, Micronesian Early Education Toolkit. This framework includes the following factors to guide improving access to ECL from disadvantaged backgrounds: ability to perceive | awareness and confidence, ability to seek | autonomy and social support, ability to reach | planned needs for care, ability to pay or no fee | within family budget and eligibility, and ability to engage | positive experience.
A Plus/Delta evaluation25 was completed for context on strengths, utility, and improvements in the ECL toolkit regarding logistical, cultural, general, and recommendations from the video face-to-face group session interviews and the open-ended responses in the ECL Toolkit Questionnaire. We used a semi-structured group interview guide, and the academic nurse partner in family practice recorded field notes-based data from the video face-to-face group sessions for the four improvement cycles. The four improvement cycles occurred between November 2020 through April 2021. The length of the sessions for four improvement cycles with PLCs were 60 minutes in November 2020, 60 minutes in December 2020, 75 minutes in February 2021, and 30 minutes in March 2021. The semi-structured group interview questions included: 1) In what ways did you find the Micronesian Early Education Toolkit helpful?, 2) What changes can be made to make the Micronesian Early Education Toolkit easier to use?, 3) How would you make the Micronesian Early Education Toolkit more specific to your culture?, 4) In what ways will you educate others on how to use the Micronesian Early Education Toolkit?, and 5) Please provide any other feedback you feel is important. The field notes-based data also included observations and verified discussions and interactions through partnership discussions. In addition, we used a self-administered online ECL Toolkit Questionnaire with five items with seven-point responses and seven open-ended questions for improvement cycles two, three, and four to evaluate the process development of the Micronesian Early Education Toolkit with PLCs (Box 3). Two academic nurse partners, of which one has a background in family practice and another has a community-based participatory research background, led the development of the semi-structured group interview guide and ECL Toolkit Questionnaire. The Executive Director of the Micronesian Islander Community organization and academic nurse partner in psychiatric mental health reviewed for inclusive language.
Box 3. Early Childhood Learning (ECL) Toolkit Questionnaire
Early Childhood Learning (ECL) Toolkit Questionnaire with five items and seven-point responses and seven open-ended questions
Please Rate the Following Statements: 1 = Strongly Disagree, 2 = Disagree, 3 = Somewhat Disagree, 4 = Neither Agree nor Disagree, 5 = Somewhat Agree, 6 = Agree, and 7 = Strongly Agree.
1. The ECL toolkit is easy to use.
2. The ECL toolkit is helpful at expanding access to ECL programs.
3. The ECL toolkit takes fits within my cultural values.
4. The ECL toolkit will be used by the Micronesian Islander community.
5. I understand how to use the ECL toolkit.
1. List two different resources available to assist Micronesian Islander community members with accessing early childhood learning opportunities.
2. Name two different early childhood learning programs in your area.
3. In what ways did you find the Micronesian Early Education Toolkit helpful?
4. What changes can be made to make the Micronesian Early Education Toolkit easier to use?
5. How would you make the Micronesian Early Education Toolkit more specific to your culture?
6. In what ways will you educate others on how to use the Micronesian Early Education Toolkit?
7. Please provide any other feedback you feel is important.
During the COVID-19 pandemic in 2020, regular attempts were made to connect with the local Salem-Keizer School District, but we did not receive return calls. In 2021, we successfully connected with the Salem-Keizer School District. Thus, in improvement cycle two, a communication collaboration effort was established with the local Salem-Keizer School District in ECL, and we provided preliminary comments and recommendations from PLCs. The local school district Early Childhood Education Coordinator and their two ECL colleagues, also reviewed the Micronesian Early Education Toolkit and provided open-ended responses. The toolkit was revised based on these findings in improvement cycle three.
The academic nurse partner in family practice analyzed the group interview and open-ended response data using content analysis and discussed and verified with community and academic partners the overarching themes. The responses from the ECL Toolkit Questionnaire were analyzed as means and ranges. We used the findings from each cycle to make subsequent improvements to the toolkit.
The ECL toolkit was named the Micronesian Early Education Toolkit by the PLCs. The Final Micronesian Early Education Toolkit consists of six chapters, key content, and a variety of educational materials (Table 2). Each chapter contains important components to ease access and navigation on available resources and ECL programs. Educational materials included the benefits of ECL, a list of local ECL programs along with specific information about each program, applications for those programs, information about free or tuition-based programs, and instructions regarding how to understand navigation of multiple requirements of the applications. As part of this ECL toolkit, a webpage was developed with links for each chapter. All video content was also provided in a downloadable text format (Appendix 1. Example of Chapter 1: Start Here!).
Table 2. The Micronesian Early Education Toolkit chapters, key content, and type of educational materials
Type of educational materials
Importance of early childhood learning and overview of program options
· Two videos “Early Childhood Learning: Why is It Important” and “Early Childhood Learning: What is It?
· Text information regarding resources available through the Salem-Keizer School District
Free early childhood learning program
· One video that educates viewer about Head Start and walks the viewer through navigating the application and what filling out the application means
· Link to download the application in English and Marshallese
· Link to an educational flyer about Head Start
Free early childhood learning program
· One video that educates viewer about Preschool Promise and walks the viewer through navigating the application and what filling out the application means
· Link to download application
Title 1 Preschool
Free early childhood learning program
· One video that educates viewers about Title 1 Preschool and walks the viewer navigating the application and what filling out the application means
· Link to download the application
· Link to an educational flyer about Title 1 Preschool
· Links to boundary maps for the district service areas
Tuition Based Preschool
Fee-based early childhood learning program
· A written list of preschools in the community including contact information and availability, service area, and costs
Other Helpful Information
Additional resources to facilitate cross-walking of multiple early childhood learning resources
· Email address to submit applications
· Links to additional information referenced in the other chapters
· Links to services that may be needed for the application process, including a link to order a copy of a birth certificate
· Written information regarding virtual pre-kindergarten classes
Appendix 1. Example of Chapter 1: Start Here! Importance of Early Childhood Learning From the Micronesian Early Education Toolkit
Early Childhood Learning
Why is it Important
Micronesian Islander Community: Health & Education
Washington State University – Vancouver College of Nursing
Welcome. In this video, we will briefly explore why early childhood learning is important for young children.
Adverse Childhood Experiences
In order to understand why early childhood learning is important, we need to know a little bit about adverse childhood experiences.
Adverse childhood experiences are traumatic events experienced during childhood. These traumatic events can include psychological abuse such as name calling or belittling, physical abuse such as hitting or kicking, sexual abuse, violence against a parent (especially the mother), witnessing substance abuse, and exposure to mental illness, suicidality, or criminal behavior.
Exposure to these adverse experiences during childhood years is associated with heart disease, cancer, lung disease, hepatitis, fractures, obesity, smoking, alcohol and drug use, and other health conditions into adulthood.
Unfortunately, children today are too often exposed to adverse childhood experiences. However, children enrolled in early childhood learning programs are less likely to experience these events. Children who are exposed are more likely to develop resilience, which are skills that allow children to bounce back from these experiences and avoid the poor health outcomes previously discussed.
Additionally, children who attend early childhood learning programs are more likely to graduate high school, have improved behaviors in elementary school, and develop improved language, reading, and imagination skills.
Unfortunately, in Oregon, 51.8 percent of 3 and 4 year old children are not enrolled in early childhood learning programs. Nationally, an estimated 53.8 percent of Pacific Islander children are not enrolled in these programs.
There may be a variety of reasons why children are not enrolled in these programs, but the goal of this toolkit is to make enrolling in these programs an easier process for parents in the Micronesian Islander community. We want to provide you with the information and resources you need to take advantage of early childhood learning opportunities.
Thank you for taking the time to learn about the importance of early childhood learning programs. Please explore all areas of this toolkit to learn more about early childhood learning opportunities and how to enroll children in them.
Following improvement cycle four (April 2021), the result was the final Micronesian Early Education Toolkit ready for PLCs to use in the application season for the 2021-2022 school year. PLCs were asked to offer their support in assisting community members in Micronesian and Pacific Islander community with enrolling their children in ECL and to use social media and word of mouth to publicize the ECL toolkit among the community. On a seven-point response questionnaire, PLCs reported that the Micronesian Early Education Toolkit respects cultural values (M=5.8; range=5-6), is easy to navigate (M=5.6; range=3-7), is feasible to help enroll preschool Micronesian Islander students (M=6.2, range=6-7), will be helpful at expanding access to ECL programs (M=6.2, range=3-7), and that they comprehend how to use the toolkit (M=6.2, range=6-7).
We provided a cross-summary of the three overarching themes on the process development of the Micronesian Early Education Toolkit and strengths and improvements made with PLCs that is a synthesis across four improvement cycles (Table 3). We identified the following three overarching themes as pillars of the final Micronesian Early Education Toolkit: 1) cultural responsiveness, 2) shared decision-making on educational materials, and 3) community reach through family/social connections. We built our work on a foundational community and academic partnership, and these three pillars are what we learned. The process lays a foundation towards increasing resilience to ACEs and improving health outcomes.
Table 3. Cross-summary of findings on the Micronesian Early Education Toolkit development, strengths, and improvements made
Findings: Micronesian Early Education Toolkit development
Findings: Micronesian Early Education Toolkit strengths and improvements made
I. Cultural responsiveness
Mutual learning and capacity building among community and academic partners18
· Cultural considerations from project team of community and academic partners included PLCs through each step of the process in order to maximize cultural responsiveness of the Micronesian Early Education Toolkit.
· PLCs described Micronesian Early Education Toolkit as being respectful of the users as individuals as well as their cultures and backgrounds.
· Although PLCs described having the toolkit and supplemental materials available in MI languages would be helpful, since PLCs speak English, PLCs could choose to interpret when assisting families with enrolling in ECL.
· Named as the Micronesian Early Education Toolkit by PLCs; enhanced sense of community ownership to be able to name the toolkit.
· Overall, PLCs and project team of partners perceived the information is specific, helpful, and easy to understand even for those who do not speak English well.
· Adjusted language in video materials to be accessible – simpler, easier to understand language
· Reworded section on homelessness questionnaire in the Head Start program video to ensure viewers understand the questions and do not feel judged negatively by the terms.
· Pictures of specific PLC families were unable to be added in order to protect confidentiality. However, stock pictures available from the University via licensing representing diversity in race were included.
· Partnership grew with participation from the local Salem-Keizer school district to share preliminary findings regarding both cultural and logistical considerations.
· Added existing translated Head Start program application in Marshallese from the local school district.
II. Shared decision-making on educational materials
Promoting empowerment and voice in shared decision-making18
· Micronesian Early Education Toolkit includes educational materials about benefits of ECL, list of local ECL programs with specific information about each program, applications for those programs, information about free and paid tuition programs, and instructions regarding how to navigate understanding and fill out the applications.
· The educational materials are provided in both written and video format.
· Links to current applications and supplemental materials are provided.
· Language and formatting were simplified based on three improvement cycles. The academic nurse partner in family practice followed-up with PLCs in those three cycles to ensure these improvements resulted in improved utility of the toolkit.
· PLCs and the project team of partners felt at ease in having offered ideas to improve the visuals and layout of the toolkit.
· PLCs and the project team of partners suggested readability/language improvements to make the video materials easier to understand.
· Overall, PLCs and the project team of partners found the format of the toolkit including written text, videos, and the web-based format helpful.
· Toolkit is easy to understand, interactive, and informative.
· Everything in the toolkit is important.
· Detailed instructions on how to fill out applications along with having the links available to the applications to be able to fill out while watching the video is helpful.
· Adjusted fonts to make text easier to read for accessibility. Text with all capital letters was changed to traditional upper and lower case to not come across as yelling.
· Added language so that users understand that the information is specific to Marion and Polk Early Learning Hub programs with link to other Early Learning Hubs in Oregon.
· Included links to flyers for ECL programs in the local school district.
· Added inks to download the written text for each video and placed before the video.
· Used consistent wording in the link for video text.
· Added disclaimer that information was for current school year only to each chapter/web pages. Added a link to the local school district webpage to ensure access to up-to-date information.
III. Community Reach Through Family/Social Connections
Building on the community’s strengths and resources18
· Engaged with nine trusted PLCs, representing various island communities, to implement the Micronesian Early Education Toolkit.
· PLCs were actively engaged as partners in developing the Micronesian Early Education Toolkit through learning by doing.
· This prepared PLCs to help members of the Micronesian and Pacific Islander community with enrolling in ECL.
· One PLC described sharing the toolkit with family and friends via Facebook and email. Another PLC described reaching out to someone who came out of prison.
· PLCs described sharing the toolkit and information learned from the toolkit with family and friends on social media.
· PLCs described sharing personal experiences with family and friends as a means to assist with providing education about ECL.
· PLCs also described using teach-back that involves repeating the contents of the toolkit in own words, to ensure understanding when sharing the information in the toolkit among the community.
· Overall, PLCs and project team of partners perceived digital format for ease of sharing through social media platforms.
· Example quote from a PLC, “Really excited to be a part of giving information to make the tool relevant. Tool will be very useful to help new families in the area.”
· PLCs described trying to navigate during pandemic and supporting each other. This included being able to spend time with all PLCs, having honest conversations, and doing for children all identified as important pieces of the work.
· Early education, motivating moms, and working together to accomplish things were also identified as important.
· Described learning about things in order to give to communities and ability to teach children lessons learned during work as important. Working collaboratively helped to provide “good vibes.”
· One PLC described her own educational journey as she works toward becoming a lawyer.
· The journey together, especially while dealing with personal struggles, and the support felt during the development and evaluation of the process were described as important.
Note. PLCs = Micronesian Islander Parent Leader Champions.
16Source: 18. Wallerstein N, Duran B, Oetzel J, Minkler M. Community-based participatory research for health: advancing social and health equity. 9th edition. San Francisco, CA: Jossey-Bass; 2018. ISBN-10:1119258855
The diversity among our community and academic partnership informed inclusion of multiple perspectives for a creative collaborative experience. For example, accessible wording of all content materials in the Micronesian Early Education Toolkit was reviewed for legal, ethical, cultural, and comprehensive understanding. Expanding the original partnership to include the advanced practice nurse scholars with a practical healthcare improvement process facilitated the partnership in continuing to translate into action for movement building with PLCs. This partnership was sustainable largely due to the commitment from all community and academic partners to cultural responsiveness, mutual learning, and humility.
PLCs represented a group of community leaders from diverse Island communities. Their variations in cultural and personal experiences allowed PLCs to each approach the Micronesian Early Education Toolkit from a unique perspective that enriched understanding on both an interpersonal and community level. PLCs welcomed the project team of MI-based non-profit community organization and public university partners into the community space that allowed for more open dialogue and understanding. We consistently referred to the grounding collaboration agreements as the Island Basket of Agreements throughout partnership building exercises with inspirational reflections, and an experiential process of improvement to ensure that these discussions were consistently a safe space to share openly. This respectful and open dialogue allowed the community and academic partners to strategically develop the Micronesian Early Education Toolkit and evaluate the experiential process of improvements for its utility and cultural responsiveness.
The approach that facilitated this open communication was used to guide the discussions with the local Salem-Keizer School District as well. These communications allowed us to receive a wealth of clarifying information that we included in the Micronesian Early Education Toolkit, resulting in a stronger resource for the Micronesian and Pacific Islander community. This dialogue and communication also enhanced the bridge between the community and a local school district. For example, we were able to provide the school district with preliminary findings from PLCs regarding wording in the homeless questionnaire in ECL program applications that may be an underlying context for some parents to not answer correctly or to not apply. The school district was unaware of that and decided to review this wording for improvement and may remove from future applications as a next step.
Our work centered the voice of PLCs. We developed the Micronesian Early Education Toolkit founded in harmonious public university and MI-based non-profit community organization partnership, cultural responsiveness, informative shared decision-making on educational materials, and community reach through family/social connections. The Micronesian Early Education Toolkit was helpful in increasing PLCs understanding of the available ECL resources and programs and utility ease of the toolkit as a crucial foundation to begin engaging and informing MI community members to enroll children in ECL programs. For future direction, we respectfully uplifted PLCs who are doing continuing work, and PLCs adapt what they learned from the toolkit, including from this creative collaboration in their respective MI community. We recommend that other similarly underserved communities adapt and develop community-specific toolkits to address needs of and strategically collaborate with community and academic partners as collective empowerment in increasing access to ECL as a key step to improving health and resilience to ACEs.
This work was supported in part by the following grant funding awards. Dr. Jacqueline Leung and Dr. Connie Kim Yen Nguyen-Truong received the Health and Education Fund Impact Partnerships #19-02778, including Northwest Health Foundation, Meyer Memorial Trust, Kaiser Permanente Northwest, Care Oregon, and Oregon Community Foundation, and also the Asian Pacific American Network of Oregon through the Wallace H. Coulter Foundation. Dr. Nguyen-Truong, Dr. S Robert Spence, and Dr. Leung received the Delta Chi Chapter-At-Large Sigma Theta Tau International Scholar Award grant. The authors are appreciative of the Micronesian Islander Parent Leader Champions from the Micronesian Islander Health & Education Program for engagement in the development and evaluation of the toolkit under the umbrella of easing access to early childhood learning. The authors are appreciative of Dr. Kandy Robertson Scholarly Professor in English, at Washington State University Vancouver for editing assistance. The authors are also appreciative of the anonymous peer reviewers for assistance.
The authors have no relevant financial disclosures or conflicts of interest.
Dr. Connie Kim Yen Nguyen-Truong (she/her/they) is a tenured Associate Professor at Washington State University College of Nursing and recognized as a Martin Luther King Jr. Community, Equity, and Social Justice Faculty Honoree. She is a National League for Nursing Academy of Nursing Education Fellow and Fellow of the American Academy of Nursing. Dr. Nguyen-Truong’s research areas include health promotion and health equity, such as culturally specific, disaggregated data; immigrants and marginalized communities; community-based participatory research and community-engaged research; parent leadership and early learning; cancer control and prevention; and diversity and inclusion in health-assistive and technology research including adoption. Dr. Nguyen-Truong received her PhD in Nursing, including health disparities and education foci, and completed a Post-Doctoral Fellowship in the Individual and Family Symptom Management Center at Oregon Health & Science University School of Nursing.
Dr. S. Robert Spence, Jr. is an alum of Washington State University College of Nursing and currently practicing as a nurse practitioner for the geriatric and complex care population. Additionally, he regularly volunteers at a local free medical clinic. The work completed by Dr. Spence and team has been recognized by and/or received awards from Washington State University, Sigma Theta Tau International Delta Chi Chapter-At-Large, American Public Health Association, and the Asian American/Pacific Islander Nurses Association. Additionally, Dr. Spence has been recognized for many academic achievements at both the graduate and undergraduate level. Dr. Spence has a passion for providing healthcare to underserved communities and for advocating for social justice and equality.
Dr. Jackie Leung (she/they) is the Executive Director of the statewide nonprofit, the Micronesian Islander Community (MIC), and is an Assistant Professor at Linfield University. Jackie’s background is in public health advocacy, policy, and research. Her work includes working in perinatal healthcare, Medicaid, early childhood education, healthcare access, chronic diseases, COVID-19 wrap-around services, and leadership pathways for community health workers. She serves in several leadership positions, including co-chairing the Commission on Asian and Pacific Islander Affairs and a traditional health worker representative on the Oregon Maternal Mortality & Morbidity Committee. In her free time, Jackie enjoys spending time with her family and long scenic drives along the coast and through the agricultural landscapes that make Oregon the beauty it is today.
Dr. Shelley Geil is Adjunct Faculty at Washington State University College of Nursing. Dr. Geil is a Psychiatric Mental Health Nurse Practitioner and an Adult Psychiatric-Mental Health Clinical Nurse Specialist. Dr. Geil has 32 years of psychiatric experience and 22 years as a Psychiatric Mental Health Nurse Practitioner.