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Nguyen-Truong N, Leung J, Waters S, Barrow N, Gonzalez K. Health and early learning, community-based participatory research and initiatives in partnership with Micrornesian islander communities, and calll to action. HPHR. 2023;57. DOI: https://doi.org/10.54111/0001/EEE3
Author note: Dr. Leung is an Associate Editor of HPHR Journal. Dr. Waters and Barrow are third co-authors.
There is a paucity of research on early learning specifically among Micronesians and Pacific Islanders. Despite, for example, Micronesians are a diverse Indigenous community, whose immigration status includes citizens from the Freely Associated States, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau, we could not ground our work supporting the experiences and needs of Micronesian families with regards to early learning within existing research. Without culturally-specific data, efforts to address unique needs and to uplift the unique strengths of communities may be hindered. An identified ongoing area of community mobilizing need is increasing parent-caregiver leadership engagement earlier on the readiness of children for formal schooling from Micronesian Islander communities. This is a crucial community identified priority area regarding Micronesian Islander Indigenous health and well-being trajectory. The purpose of this editorial article is to share our perspective on highlights of early learning research and an overview on CBPR and initiative efforts of the Health and Education Program with Micronesian Islander Parent Leaders in the United States Pacific Northwest. We describe implications for CBPR with a call to action and contextual considerations in CBPR trends.
There is a paucity of research on early learning specifically among Micronesians and Pacific Islanders. Despite, for example, Micronesians are a diverse Indigenous community, whose immigration status includes citizens from the Freely Associated States, including the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau,1 we could not ground our work supporting the experiences and needs of Micronesian families with regards to early learning within existing research. Without culturally-specific data, efforts to address unique needs and to uplift the unique strengths of communities may be hindered.
A community-academic partnership was originally developed in 2018 to mobilize the diverse Micronesian Islander community. In prior community-based participatory research (CBPR) initiatives conducted by researchers (first and second authors) from the original partnership, including the non-profit Micronesian Islander Community (MIC) organization and public Washington State University College of Nursing with Micronesian Islander Parent Leaders (MIPLs) in the United States (U.S.) Pacific Northwest, an identified ongoing area of community mobilizing need is increasing parent-caregiver leadership engagement earlier on the readiness of children for formal schooling from Micronesian Islander communities.1-4 This is a crucial community identified priority area regarding Micronesian Islander Indigenous health and well-being trajectory.
The MIC-academic nursing partnership collaborated with allies, including human development and prevention science (third author) and mentees from graduate nursing research (another third author) and undergraduate public health (fourth author) to write this editorial article. We are multi-disciplinary authors and have a shared commitment on centering Indigenous health and well-being. Thus, the purpose of this editorial article is to share our perspective on highlights of early learning research and an overview on CBPR and initiative efforts of the Health and Education Program with MIPLs. We describe implications for CBPR with a call to action and contextual considerations in CBPR trends.
The following studies shed light on early learning research. Researchers recommend actively working with families, including parent-caregivers and children5 and using an ecological,6,7 developmental ecological systems,8 or social exchange theory.6 Several studies underscored the importance and positive impacts of family/parent-caregiver preparedness or engagement and readiness of children, transition to kindergarten (start of formal schooling).5,6,9-12 Children’s emotional adaptation during the first school days and the families’ impression of being ready for school was related; families’ preparation is explained in part by how much they practiced transitions.5 An inclusive environment for early learning is important. Researchers found in a review of the literature that an ecological system influences the education of a child/children, and this includes parents-caregivers and siblings of the microsystem; peers and school of the mesosystem; community connections of the exosystem; and cultural identity of the macrosystem.8
There are several factors to consider that can co-occur within children and approximation of the lived environment that shapes developmental health and school readiness.7 Socioeconomic status, race-ethnicity, parental/caregiver age, and maternal nativity were positively related with children’s developmental ecology.7 Early learning and home-based engagement were positively associated for families with low household income11 and with children’s academic achievement and social skills.12 Exposure to a community-level-focused parenting education curriculum program for improving readiness of children ages birth to 5 years old for kindergarten had positive results.10 Children of families who were exposed to such a program had statistically significantly higher readiness scores on both entering kindergarten reading and math assessments than children whose families were not exposed.10 Parents and early learning providers need to develop a collaborative relationship with the child’s needs as the focus.9 Despite available research evidence-informed studies, we were unable to locate research evidence-based studies, particularly among Micronesian and Pacific Islander communities. In an integrative literature review, the emphasis was on respecting the cultural and ethnic ideals of the families being served by an early learning program and not necessarily within the held beliefs of teachers, administrators, and policymakers.6
The MIC-academic nursing partnership worked with MIPLs from diverse Island communities starting in 2018 in a series of CBPR and scholarly initiatives as the Health and Education Program.1-4,13 Details are previously published elsewhere. 1-4,13 We provide an overview on the capacity building and implementation journey of the Health and Education Program.
The MIC-academic nursing partnership used the innovative modified qualitative participatory-driven, group-level assessment method with illustrative storytelling (modified by the first author) that involved Chuukese and Marshallese MIPLs in having generated data as written words and drawn pictures by having told stories and analyzed in real time with researchers.3 MIPLs were able to discuss barriers to healthcare, including reproductive health concerns such as stillbirth and miscarriages, and struggle with the U.S. public school system, including school readiness and progression among Micronesian Islander children with mental and developmental disabilities.2 This partnership developed the Building Safe Didactic Dialogues for Action Model with four key pillars. This provided a cultural lens for the foundation to establish trust and rapport, and develop stress reduction strategies among parents and caregivers.2 This partnership took over one year to build capacity and underwent evaluation as a research evidence-based culturally specific leadership curriculum with MIPLs titled, Rekki Lemnak (Thinking of) Parent Leadership.1 Important evidence on combined CBPR and empowerment education approaches achieved leadership and research skill capacity for the long-term sustainability of the research, partnership, and confidence within MIPLs to use their voices for action.1 Our CBPR partnership learned from MIPLs who identified early learning and development as a community priority. Many Micronesian Islander children were not attending preschool then, limiting access to early learning.2 As part of the ongoing partnership, the CBPR partnership recognized the need to explore methods to support families with adverse childhood experiences. Prior literature discusses how early learning mitigates adverse childhood experiences.4,14 MIC-academic nursing partnership expanded in collaboration with an advanced family nurse practitioner student scholar and psychiatric mental health nurse practitioner13 and co-designed and implemented with MIPLs the Micronesian Early Education Toolkit and begun reduction of barriers to enrolling Micronesian Islander children in early learning programs in the U.S. Pacific Northwest.4
Building trust and rapport in a community-academic partnership can be ongoing and important for sustainability. Our partnership established trust and rapport in prior CBPR community engagement work with Micronesian and Pacific Islander communities.2,15 Engaging with Micronesian and Pacific Islander community leaders and community health workers is important.1-3,16,17 This is important as a best practice that uplifts collaboration by, with, and for the community. Following cultural practices, the partnership had talk story and shared food that was identified for engagement, reciprocity, social inclusiveness, and honoring collectivist cultural structure.2-4,17 While these are tremendous CBPR and initiative efforts, there continues to be a need to build the research evidence-base in health and well-being among Micronesian and Pacific Islanders, including parent-caregiver leadership engagement earlier on the readiness of children for formal schooling.
Our community-academic partnership with Micronesian Islander communities has, nevertheless, developed and strengthened because of a commitment to engagement, trust, and relationship building through culturally-sustaining activities and practices. This commitment has focused research on community-identified priorities and centered the leadership of community members, such as parents-caregivers. CBPR has also resulted in innovative approaches to data generation, collection, and meaningful interpretation. This ongoing partnership continues to adapt responsively to the needs and priorities of the community and is offered as an example of how CBPR can support building the research evidence-base regarding the health and well-being of Micronesian Islander communities. We recommend to organizations who are planning to form or expand partnerships to respond to community identified priorities and consider what their shared initiatives are while centering uniqueness of different groups.
The following are contextual considerations in CBPR trends. We recommend partnerships to discuss what would be relevant and helpful in their work with Micronesian and Pacific Islander communities and with different groups.
Prior research often overlooked community and academic relationships, although critical in CBPR and community engagement approaches to generating knowledge about and improving the lives of people encountering inequities.18 Community-based organizations may receive calls from researchers with whom they do not have an established relationship and ask to help recruit or may be asked to partner. There is a community-facing screening tool to assist community organizations with decision-making on which requests to pursue, particularly when receiving spontaneous requests from researchers.19 The screening tool includes items on why choose us as an organization, how the research/project benefits an organization and the communities they serve; what is the research/project objective, essential questions, and who seeks to enroll in the research/project; where at in the research/project process; the timeline; what specific resources need; what amount funding is available for the work; and what activities asking to contribute at no cost.19 Making an informed decision on whether to partner and how a relationship might be formed or built can take time.
There is a growing literature on frameworks in regards to evaluating and measuring success in CBPR partnerships to help inform addressing and improving health equity.20-23 For example, Ward et al.20 discussed an integrative CBPR and Health Impact Assessments framework that would meaningfully engage communities in decision-making to influence health and evaluate partnership effectiveness. In another example, Israel et al.22 described Measurement Approaches to Partnership Success (MAPS) by applying a theoretical and methodological approach to examine long-term CBPR partnerships, and Coombe et al.23 developed measures of partnership synergy as a dimension of MAPs to get at that role in collaborative approaches to research and action. The science of CBPR/community engagement partnerships and measuring success in partnerships can be one way to address and improve health equity. Although we shared examples, we recommend emerging, established, or expanding partnerships to consider and discuss a framework or approach that would align with their shared mission to guide on how want to learn and work collaboratively.
In this editorial article, we share our perspective on highlights of early learning research and an overview on CBPR and initiative efforts of the Health and Education Program with Micronesian Islander Parent Leaders (MIPLs). The need to address inequities in health and well-being among Micronesian Islander communities and to the extended Pacific Islander communities is critical to community health, population health, and public health and requires this CBPR approach. Our example efforts, learnings, and advances in health equity are offered as part of a call to action to health and human services researchers and practitioners – to uplift Micronesian and Pacific Islander families and communities and ensure the research and initiatives is by, with, and for them. We made recommendations in the context of Micronesian and Pacific Islanders and honor the uniqueness of these groups and different groups as well.
Dr. Jacqueline Leung, Dr. Connie K Y Nguyen-Truong, Dr. Sara F Waters, and Natasha Barrow, MNPH, BSN, RN, received the ODE Early Childhood Equity Fund Grant #14681 that funded in part the evidence-based editorial scholarly work. Dr. CKY Nguyen-Truong received the Washington State University Vancouver Nursing faculty development fund that partially funded the dissemination. The authors are appreciative of Dr. Kandy S. Robertson PhD, Scholarly Professor in English and Washington State University Vancouver Writing Center Coordinator for editing assistance on an earlier version. The authors are also appreciative of the HPHR Journal Editorial Team and anonymous peer reviewers.
The authors have no relevant financial disclosures or conflicts of interest.
Dr. Connie K Y Nguyen-Truong (she/her/they) is a tenured Associate Professor at Washington State University, Department of Nursing and Systems Science, College of Nursing in Vancouver. She is recognized as a Martin Luther King Jr. Community, Equity, and Social Justice Faculty Honoree. She is a Fellow of the National League for Nursing Academy of Nursing Education and American Academy of Nursing. Dr. Nguyen-Truong’s research is across sectors and multidisciplinary, and with community and health organizations and leaders, community health workers, students, and faculty. Areas include health promotion and health equity, culturally specific data; immigrants, refugees, and marginalized communities; community-based participatory research/community-engaged research; parent leadership and early learning; diversity and inclusion in health-assistive and technology research including adoption; and cancer control and prevention, and anti-racism. Dr. Nguyen-Truong received her PhD in Nursing, including health disparities and education, and completed a Post-Doctoral Fellowship in the Individual and Family Symptom Management Center at Oregon Health & Science University School of Nursing. (ORCID ID 0000-0002-3933-5532)
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. (ORCID ID 0000-0002-6401-3789)
Dr. Sara F Waters is a tenured Associate Professor at Washington State University Human Development Department in Vancouver in the College of Agricultural, Human, and Natural Resource Sciences. Dr. Waters research areas include children’s emotional and physiological self-regulation, child-caregiver attachment bond, biological mechanisms linking early adversity to health outcomes, preventive interventions for trauma-exposed families, and anti-racism. Dr. Waters received her PhD in Human Development at the University of California, Davis, and completed a Post-Doctoral Fellowship in the Department of Psychiatry at the University of California, San Francisco. (ORCID ID 0000-0003-4732-2894)
Natasha Barrow is a tenure track faculty at Bellingham Technical College. She teaches in the pre-licensure associates degree nursing program. Natasha is also a PhD Candidate in the College of Nursing at Washington State University Spokane Health Sciences. Her research focuses on upstream perspective on burnout in nursing students. This research focus is on the impact on retention of newly licensed nurses and extent of burnout and stress while in their respective nursing program. As a graduate research assistant, she has collaborated on cross-sectoral, multidisciplinary, and community-based participatory research on anti-racism, health and early learning, and diversity and inclusivity. She is specializing in stress contexts, including in nursing and immigrant, refugee, and marginalized communities. Natasha has had the invited opportunity to collaborate with Dr. Connie K. Y. Nguyen-Truong, Dr. Jacqueline Leung, Dr. Sara F Waters, and Karen N. Gonzales on research with the Micronesian Islander Community organization and community in the context of health and early learning. (ORCID ID 0000-0001-6824-3437)
Karen Nicolas Gonzalez is an undergraduate student scholar pursuing a public health, health promotion degree at Linfield University. Throughout her years at Linfield, Karen has been part of Tri- Alpha, an honor society for first generation students. Karen has also been a first-generation peer mentor for the past three years. Karen received a mentored scholarly dissemination collaboration experience from Dr. Connie K. Y. Nguyen-Truong and Dr. Jacqueline Leung and collaborated with Dr. Sara F. Waters and Natasha Barrow, MNPH, BSN, RN, through the academic and Micronesian Islander Community organization partnership. Karen is interested in helping minoritized communities have access to healthcare. She wants to continue to do research regarding diseases and ways to lower the cost of healthcare. (ORCID ID 0009-0007-4865-9452)
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