Leung J, Nguyen-Truong C, Waters S. The COVID-19 pandemic impact and lessons learned on sustainability of a Micronesian islander parent leadership program . HPHR. 2023;60. https://doi.org/10.54111/0001/HHH2
Micronesian and Pacific Islander (M&PI) communities were hit the hardest with COVID-19 cases, 154 to 217.7 per 100,000, compared to other racial-ethnic groups, particularly in the western United States. In Oregon, COVID-19 cases and death rates among M&PI were higher than all other racial and ethnic groups. Micronesian Islander Parent Leaders (MIPLs, including parents and caregivers of children) of the expanded Health and Education parent leadership program in Oregon express concern about the COVID-19 impact on their health and M&PI families and learning on children. Investment in leadership development is shown to have often increased acceptance, development, implementation, and translation of interventions within the M&PI communities. The COVID-19 pandemics’ impact on CBPR must be recognized when conducting CBPR. Consequences include interrupted formal education and parents’ mental health as unintentional proxy educators for children as students with distance learning. We report on a qualitative descriptive study on the COVID-19 impact on the learning of MIPLs and their families, with MIPLs being caregivers as key informants. We describe lessons learned as notes from the field from our experience as the Micronesian Islander Community (MIC) non-profit organization and public Washington State University as a community and academic partnership navigating the COVID-19 impact in conducting CBPR. This community and educational partnership had two major responsive pivots in navigating the COVID-19 impact in working with CBPR. The shift in the project was a necessary methodical resilient strategy for the sustainability of the M&PI parent leadership program.
Micronesian and Pacific Islander (M&PI) communities are hit the hardest with COVID-19 cases, 154 to 217.7 per 100,000, compared to other racial-ethnic groups, particularly in the western United States.1 M&PIs also have the highest attributable COVID-19 deaths between ages 15-24 and 45-84 years old than non-Hispanic Whites.2 Furthermore, in Oregon, COVID-19 cases and death rates among the M&PI cases are higher than all other racial and ethnic groups. Micronesian Islander Parent Leaders (MIPLs, including parents and caregivers of children) of the expanded Health and Education parent leadership program in Oregon express concern about the COVID-19 impact on their health and M&PI families and learning on children.
Social justice educational leadership preparation in the margins underscores the importance of equity-mindedness and social justice that centers on the often overlooked in the literature – parent engagement and community organizing.4 The details on the origin and growing M&PI Health and Education parent leadership development, capacity building through community organizing, and engaging MIPLs advocating for families and children with a community and academic partnership are described elsewhere.5,6,7,8 Investment in leadership development is shown to have often increased acceptance, development, implementation, and translation of interventions within the M&PI communities.6,7,9,10 We learned from prior work from MIPLs that a mother’s knowledge passing from a parent to child(ren) and enhancing parent leadership skills early in children’s lives for learning and development is vital in raising M&PI children and a health priority in community-based participatory research (CBPR). Caal and colleagues’ Opening Doors/Abriendo Puertas study,11 a parent leadership program for Latinx parents, can help to shed light. Through a collaborative community and academic partnership building, Latinx parents developed and demonstrated advocacy and leadership skills in being their children’s first teachers.11
Researchers found that engaging with community stakeholders early in the project design planning amplifies their voices.6,8,12,13 During the unprecedented time of the COVID-19 pandemic, the impact must be recognized to be able to navigate conducting CBPR. Impacts include interrupted formal education of children and parents’ mental health as unintentional proxy educators for children via distance learning.14 School closure due to COVID-19 has been a significant source of stress for parents.15 An examination of households via the National Panel Study of the Coronavirus pandemic found that as proxy educators during distance learning, parents whose children struggled to adapt to a distance learning pedagogy experienced high levels of mental health distress.16 Parental poor mental health has long been linked to children’s mental health, psychological well-being, and behavioral problems.17 The changes to formal education in response to the COVID-19 pandemic may impact parents and children of marginalized and minoritized communities in significantly negative ways.
The purpose of this brief is to describe a work in progress. We report on a qualitative descriptive study of the COVID-19 impacts on the health and learning of MIPLs being caregivers as key informants. We describe field note lessons from our experience as the Micronesian Islander Community (MIC) non-profit organization and public Washington State University as a community and academic partnership navigating the COVID-19 impact in conducting CBPR. Due to the COVID-19 pandemic, our CBPR project shifted in response to the needs and interest of the MIPLs.
The CBPR study was determined exempt by the Washington State University Human Research Protection Program.
The CBPR study was virtually implemented via videoconference from March through June 2021 with 100% social distancing during the COVID-19 pandemic. Seven MIPL adults from the expanded Health and Education parent leadership program participated in four group interview discussions for about 1.5 to 2 hours per session. MIPLs were community residents as key informants who represented diverse Island communities, including CHamarro, Chuukese, Kapingamarangi, Pohnpeian, and Marshallese. The academic nurse principal investigator (PI) with a Vietnamese and Guamanian MI background and the Executive Director/community PI at MIC reviewed and obtained voluntary study consent from key informants. We used a semi-structured and open-ended group interview guide (Table 1), resulting in rich, thick descriptions of perceptions and experiences. The community PI primarily facilitated the participatory group interview discussions, and the academic nurse PI co-facilitated and recorded field notes-based data transcripts via participatory group-level assessment.7,18 The field notes-based data transcripts were hand-coded and organized into central themes, discussed, reflected, clarified, and verified interpretations with MIPLs in real-time, and used conventional content analysis during the participatory group interview discussions. 19 Reflexivity was used as a technique to address the influence of personal biases on findings. Each participant received a $25 shopping gift card at the end of each group interview discussion.
Table 1. Semi-structured and open-ended group interview guide during the COVID-19 pandemic with Micronesian Islander Parent Leaders as Key Informants
In early March 2021, the local Salem Keizer schools (in the United States Pacific Northwest) are reopening and providing in-person or hybrid as a combination of in-person and virtual learning format options. For example, this week, Kindergarten and 1st grade reopened for two days a week for five hours per day.
· What are your children doing for school right now?
In late March 2021, we are continuing with our open discussion on schools re-opening.
For families with children who have returned to school as in-person, how are you doing? How are your children doing?
· For families with children who are staying with virtual for school, how are you doing? How are your children doing?
In April 2021, we will have an open discussion about the COVID vaccination.
· What are some of the needs of your community?
In June 2021, we will have an open discussion about how your family has been doing.
· How did your family do when school resumed in-person or as hybrid when you were going half time in-person and half time virtual?
· How do you feel about the school opening full time in fall 2021? Will you stay virtual or are your children going back to school in-person full-time?
· Share how COVID-19 has affected you and your family and what you have done to adjust. Please also share if you have children who are not ready to go to school yet age wise.
The following are examples of following-up and probing questions:
· What worked for you or did not work for you?
· What and how did it work well and did not work well?
· What needs to be changed?
· Please give us an example or examples.
· Please tell us more. Please provide more details/expand on…
· What are your desires regarding…(for example, leadership, health, and education)?
· What are barriers regarding…(for example, leadership, health, and education)?
We also maintained a field journal of our community and academic partnership debriefings regarding lessons learned as notes from the field. We used a Plus/Delta evaluation20 for context on lessons learned and verified debriefings and interactions through discussions.
Following the workshops, MIPLs were invited to the program’s second stage to provide training so that participants could become “Cultural Ambassadors” to their community as MIPL leaders. However, due to the COVID-19 pandemic, the program shifted the CBPR project.
Seven MIPL key informants were identified as follows: CHamarro and Filipino (n=1), Chuukese (n=1), Kapingamarangi (n=1), Pohnpeian (n=1), and Marshallese (n=3). The average age of MIPLs is 40.14 years old (range=24-63), and they lived on average 16.71 years in the United States (range=3-36). All identified as a parent or a caregiver, including a mother, grandparent, or aunt caring for a child or children ages prenatal to middle school age.
After reviewing notes from the discussions, the academic nurse researcher PI, Executive Director/community PI, and MIPLs identified four main themes, including 1) children’s struggles to adjust from in-person to virtual learning and from virtual to in-person learning, 2) MIPLs’ persistent struggles to adjust from virtual to in-person learning, 3) social communication and connection, and 4) trying to manage children’s education while caring for family members with COVID-19. See Table 2 for the main themes and additional quotes.
Table 2. Main Themes and Example Quotes from 7 Micronesian Islander Parent Leaders as Key Informants
Example quotes from Micronesian Islander Parent Leaders as Key Informants
Children’s struggles to adjust from in-person to virtual learning and from virtual learning to in-person
Adjusting from in-person to virtual learning
“I was kind of mad of the teacher…the teacher did not talk to him [referring to son]. I called the school. They send me a message and said to meet them [referring to school Principal] by the zoom. Why not the phone? Sometimes it’s hard for me when they send the link. My son…English bilingual language. They always kick him out when he is done. Then the teacher said that he failed the class. I think he needs to go back to school. It is hard for me. We don’t have any room to put him in own room. Need to keep other siblings from that room. My little one, the baby can’t even stay there. They just run around. Son’s teacher keeps kicking him out. I really want to know so that I can help him, step in. Why he’s failing?” (Marshallese F)
“They [referring to grandchildren] don’t like staying home. When they go study online, then we have them go online. Trying to help them.” (Kapingamarangi M)
“My kid [is] in middle school and is in school [for] two days in-person…This is a struggle for my daughter. My daughter is learning to adjust being back in-person. Getting back to get at a normal level…I really like how we are sharing so that we are not going through this alone.” (Pohnpeian P)
MIPLs’ persistent struggles to adjust from virtual to in-person learning
“It’s still hard”
My child pretty much stayed home the year. She pretty lost…I tried my best to keep her engaged in her classes. It’s still hard. I’m getting her to sign for tutor service. Hopefully, that will be going to start soon. That is really where we’re at.” “…I tend to get depressed. Struggling in things in life [for example, taking care of older parent]” (Pohnpeian P)
Concerns about physical health of children and the extent of teachers’ role
“My nephew goes to school Monday through Friday. Still nerve wracking. We don’t know what exposure [referring to COVID-19] may look like. He’s enjoying it [referring to in-person learning], but still feels uncomfortable. This is a kid who licks his hand and touches everything. The teacher can’t do the monitoring. Can’t blame the teachers because there are so many students and priorities…” (Chamarro and Filipino B)
Social communication and connection
“Be honest, I was having a hard time. It is really harder on me…One of the staff at school had COVID. I don’t really know if the teacher really teaches them to wash their hands. All of my kids [and I], we didn’t get positive for COVID. I don’t know if their kids [referring to other students] have COVID. To let them [referring to own children] go to school is hard. You never know. It’s hard for me.” (Marshallese M)
“My child [referring to nephew] has autism and goes to school from Tuesday to Friday, 12:30-3:30pm. My niece goes to her school two times a week; takes morning classes from 8:00 to 1:00pm. I like them going to school so that they can interact with friends. My son is going to preschool. Going Monday to Thursday… My son…likes to be in school more. [referring to attending school in-person] (Marshallese J)
“My teenage daughter use to cut school. Mom, I kind of like how school is right now where my friend does not say let’s go here and there. At home, she is more focused. [referring to attending school virtually]” (Marshallese J)
“Middle school. I don’t think she [referring to daughter] connected well during this time [referring to the COVID-19 pandemic]. [expressed a need for Micronesian and Pacific Islander community] Just some kind of normal. A normal that everyone can get back to. That can help with stress, mental health issues that people are going through.” (Pohnpeian P)
Trying to manage while taking care of family members with COVID-19
“…We trying to manage and us trying to hold onto our jobs. Jumping from this job to another job and being a full-time mom. Doing what I can because my husband cannot cover [referring to a family member who has COVID-19]…want the best for our child…they are students at home…I am the teacher even if I am not dressed up…Children said that the teacher said to do it this way. I tried to show them the easier way. I am really looking forward to that full-time in school. The hardest thing is making them do things. Back home [referring to the Island] we [would] call [this] no schoolers.” (Marshallese M)
“My husband got positive [referring to COVID-19]….a leader…told me that I cannot go anywhere. But I need to provide for family. I am not the one who’s positive, but I have to quarantine because my husband gets positive. Where am I going to get food from?…I am cleared [referring to testing negative for COVID-19].” (Marshallese F)
“Last year, I had the COVID-19…and my boyfriend but at the same time I was pregnant…But thank God… my older daughter didn’t get the virus. Only me and my boyfriend, and the rest of everyone in our household…This year I am really thankful that I took the test again, and…it negative. Fully recovered now.” (Chuukese R)
Children were told to be ‘in separate rooms for the lessons’; however, they lived in a one-bedroom home, which was not practical for the family of four. The MIPL described the technical issues, as the teacher would not permit the student to enter (despite being in the waiting room before class time) or if the student was in the classroom and a sibling or the parent appeared in the background during the lesson, the teacher would automatically remove the student from the virtual classroom. See Table 2 for Marshallese F quote.
Another MIPL talked about the vital change their child experienced in an online environment. Previously, their daughter would skip classes. However, in the virtual environment, she began to have consistent attendance and thrived well academically.
My teenage daughter use to cut school. Mom, I kind of like how school is right now where my friend does not say let’s go here and there. At home, she is more focused. [referring to attending school virtually] (Marshallese J)
When school resumed during the COVID-19 pandemic, the school policy was a hybrid approach, where students would attend in person some days and virtually on other days. A MIPL described the challenges their child faced with returning to school.
My kid [is] in middle school and is in school [for] two days in-person…This is a struggle for my daughter. My daughter is learning to adjust being back in-person. Getting back to get at a normal level…I really like how we are sharing so that we are not going through this alone. (Pohnpeian P)
The need for social connection and building relationships was also discussed. Being in person provided a sense of community and being surrounded by Micronesian or Pacific Islander people.
Middle school. I don’t think she [referring to daughter] connected well during this time [referring to the COVID-19 pandemic]. [expressed a need for Micronesian and Pacific Islander community] Just some kind of normal. A normal that everyone can get back to. That can help with stress, mental health issues that people are going through. (Pohnpeian P)
MIPLs described the challenges of supporting their children’s education (whether online or hybrid) and preventing COVID-19 infection from occurring within the household. There were concerns about job and income loss, and whether they would be able to stay in their home, but also worry when school would resume in person.
…We trying to manage and us trying to hold onto our jobs. Jumping from this job to another job and being a full-time mom. Doing what I can because my husband cannot cover [referring to a family member who has COVID-19]…want the best for our child…they are students at home…I am the teacher even if I am not dressed up…Children said that the teacher said to do it this way. I tried to show them the easier way. I am really looking forward to that full-time in school. The hardest thing is making them do things. Back home [referring to the Island] we [would] call [this] no schoolers. (Marshallese M)
The MIPL leadership program would have continued with the training for participants to become ambassadors of a cultural-specific program called “Opening Doors;’ however, due to the ongoing pandemic and family obligations, MIPLs withdrew from the program. As such, this necessitated a change in the next steps for the program, as outlined below in the Lessons Learned section.
MIPLs described significant challenges as they adapted to multiple changes to their children’s learning environments due to the COVID-19 pandemic. We could not find any research focused on Micronesian Islanders’ experiences with virtual learning during the pandemic, but we saw connections between our findings and those of other literature. For instance, the dissatisfaction with virtual learning shared by MIPLs aligns with concerns expressed by parents in Wuhan, China, about the negative impacts of virtual learning on their children during the early stages of the pandemic.21 Caregivers’ ambivalence about the return to in-person learning22 and children’s difficulty transitioning back to in-person learning,23 as identified by MIPLs, has also been found in the literature.
On top of changing learning needs, MIPLs described the additional demand of caring for family members with COVID-19. This circumstance added concern for the family member’s health and subtracted the support they could provide if they were well. This experience resonates broadly, as the pandemic has exacerbated the disproportionate burden of care born by women.24 The MIPLs navigated decision-making regarding learning format options, supporting children across learning environments, and taking care of family members with COVID-19, all within the larger context of dramatic increases in xenophobia and racism against Asian-Americans and Pacific Islanders.25 These themes were also present in one of the only studies to focus on the pandemic-related experiences of Pacific Islanders, specifically.26 In this work, participants discussed the negative impacts of COVID-19 on children’s schooling and families’ mental and physical health, among other things. The ongoing nature of these educational, health, and systemic difficulties during the pandemic could lead to overwhelming caregiver burden or parental burnout,27 which are linked to children’s adverse stress outcomes.28,29 The need for adequate support for MIPLs continued through the ongoing impacts of the COVID-19 pandemic on them and their families.
Parent engagement and children’s participation in high-quality early childhood education programs can help facilitate children’s school readiness.11 While we were able to gather data and stories on the experience of the COVID-19 pandemic on MIPLs, the academic and non-profit partnership shifted priorities as the pandemic continued.
First, our ability to shift from in-person to wholly online moved the dynamics of the MIPL group. It was a learning experience for many MIPL families, as several relied on their children’s electronic devices (provided by the schools) or their children’s ability to troubleshoot electronic access issues. Our discussions focused on community needs, health outcomes, and educational challenges experienced by the MIPL and their family.
After completing the initial portion of the MIPL program, five (of seven) MIPLs from the Health and Education parent leadership program completed the Opening Doors/Abriendo Puertas certified facilitator virtual national training program in March 2021. The MIPLs would serve as Cultural Ambassadors, modifying the Opening Doors/Abriendos Puertas program, which helped the Latinx communities to become a Micronesian-specific curriculum. The next phase of the CBPR study was for MIPLs to facilitate the curriculum with the community and academic partnership as a feasibility and acceptability pilot test. The Cultural Ambassadors chose the dates of the work sessions. The first work session in April 2021 to work on culturally specifically modifying the curriculum had total attendance. However, the following three work sessions in May, June, and September 2021 were rescheduled and canceled due to high absences. We deeply reflected on what we learned from the qualitative description CBPR study described earlier. Although all Cultural Ambassadors initially expressed interest and were engaged in having identified the purpose, longer length of a curriculum with ten interactive sessions, and their roles, the fourth work session in October 2021 did not get rescheduled and due to the overall high absences and not working well for parent leaders resulted in the cancellation of the M&PI Opening Doors parent leadership program.
Second, two of the five Cultural Ambassadors were hired as the Project Director and Community Health Researcher Worker staff and completed facilitator training for a different parent leadership program, Ready for Kindergarten! curriculum. This shorter curriculum consists of three interactive workshops for parents caring for children of varying age groups, identified by MIC and prior MIPLs as an alignment for M&PI families.
Our next steps include examining if the Ready for Kindergarten! Curriculum as a parent leadership program will increase parent-child interaction for M&PI communities.
This work was supported in part by the following grant funding awards. Dr. Jacqueline Leung, JD, MS, CHW, and Dr. Connie Kim Yen Nguyen-Truong, PhD, RN, ANEF, 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; Asian Pacific American Network of Oregon through the Wallace H. Coulter Foundation; and Oregon Department of Education Early Childhood Equity Fund (ODE ECEF) Grant # ECEF20_113. Dr. Jacqueline Leung, JD, MS, CHW, Dr. Connie Kim Yen Nguyen-Truong, PhD, RN, ANEF, and Dr. Sara F. Waters, PhD, received the ODE ECEF Grant #14681. The authors appreciate the Micronesian Islander Parent Leaders from the Micronesian Islander Health & Education Program for engagement. The authors are also appreciative of the anonymous peer reviewers for assistance.
The authors have no relevant financial disclosures or conflicts of interest.
Dr. Jacqueline (Jackie) Leung is the Executive Director and a Public Health Advocate at the Micronesian Islander Community and an Assistant Professor at Linfield University Health Human Performance, and Athletics, with an emphasis in Public Health. Dr. Leung’s research areas include parent leadership and education, prenatal healthcare access, and utilization of healthcare services. As a community leader, Dr. Leung is involved with community engagement, outreach, organizing, and advocates for Micronesian and Pacific Islanders.
Dr. Connie Kim Yen Nguyen-Truong (she/her/they) is a tenured Associate Professor at Washington State University College of Nursing and recognized as an Inclusive Excellence Scholar in Residence, Martin Luther King Jr. Community, Equity, and Social Justice Faculty Honoree, and March of Dimes Distinguished Nurse Hero of the Year. 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 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, and anti-racism. 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. 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.