UNC School of Social Work Associate Professor Mimi Chapman has shown that art can be used as a teaching tool for helping students, educators, and social workers to better understand the migration and cultural life experiences of Latinos and other diverse populations. Now, thanks to a $300,000 federal grant, Chapman and a trans-disciplinary team of UNC scholars are preparing to investigate whether art can also help to enhance the health care of Latino adolescents.
The National Institutes of Health (NIH) and the National Endowment for the Arts (NEA) are funding the two-year collaborative study, which brings together professional colleagues and researchers from across the University campus. Co-investigators for the project are: Tamera Coyne-Beasley, a professor at UNC’s School of Medicine; Robert Colby, art historian and visiting research instructor at UNC’s School of Social Work; Steven Day, a research assistant professor at the School of Social Work and project manager; Geni Eng, professor at the School of Public Health; Alexandra Lightfoot, director of the Community-Based Participatory Research Core at UNC’s Center for Health Promotion and Disease Prevention; John McGowan, professor with the Institute for the Arts and Humanities; and Keith Payne, associate professor in Social Psychology. Will Hall, a doctoral student in social work, Alexandra Shayne-McKnight, a first year MSW student, and Kent Lee, a doctoral student from social psychology are also collaborating on the project.
The study will target 80 pediatric residents and will center on the use of visual materials, such as photographs, and structured discussions as a method for strengthening the relationship between healthcare providers and Latino adolescents.
Improving this bond will depend largely on encouraging participants to consider their own implicit biases and how their unconscious thoughts, feelings, and beliefs may affect the medical treatment that they provide to racial and ethnic minorities. Research has suggested that there is a link between how racial and ethnic minorities are viewed and the health care that they receive. Other studies have shown that minorities continue to shoulder disproportionate rates of preventable diseases, disabilities, and deaths compared to whites.
Although implicit bias is not unique to the medical profession, Chapman said it is being “thought about more as an explanation for continuing health disparities, even when barriers such as access have been overcome.”
“What this may mean is that, as a provider, I believe and aspire to do what’s best for my patients,” she said. “But because I’ve been raised in particular ways or because of the society I live in and the stereotypes that exist, there are still assumptions that I may make about a patient the moment I see them that I’m not aware of because the assumptions are activated so quickly. Our goal is to see if we can make a real difference in implicit attitudes that are activated in a split second when we see someone.”
The study will focus on new immigrant and Latino teens, not only because of North Carolina’s growing Latino population but because Latino youth are experiencing disparate health outcomes. In addition, adolescence is a time when youth begin using health care on their own and as a result, their experiences with providers can set the tone for how these youth will seek and use care as adults, Chapman said. Thus, pediatricians who have a greater understanding of a Latino adolescent’s experiences, including with doctors and hospitals, may offer better care and help to reduce racial inequities, she said.
“For example, pregnancy rates among Latina girls are higher than those for other groups and yet, recent research suggests contraceptive use among Latinas may have a particular cultural overlay that physicians and other providers would benefit from understanding,” Chapman explained.
The collaborative project, which will build on some of the associate professor’s current work with art and social work research, centers on an intervention that the UNC team is calling, “Yo Veo Salud,” or “I See Health.” The intervention will include discussions around a series of photographs that capture the complex reality of a family from Mexico before and after their immigration to the United States.
The photographs are part of an ongoing project by photojournalist Janet Jarman, who has worked closely with Chapman and Colby over the last few years. Chapman and Colby have used Jarman’s pictures as part of a popular training experience to help middle school teachers in North Carolina better understand the experiences of their Latino students. Educators have praised the photographs for stimulating difficult discussions around their own unconscious biases and for helping them to express more compassion to the immigrant children and families in their schools.
The intervention will also incorporate “PhotoVoice,” a participatory exercise that gives marginalized groups a voice through the use of photography. For the UNC project, Latino adolescents will be given cameras and encouraged to capture pictures that represent their lives, including their experiences with health care. The photos will eventually be shared as part of the continuing discussion with the study’s participants around implicit bias, Chapman said. Lightfoot, Eng, and Florence Siman of Raleigh’s El Pueblo will lead the PhotoVoice component of the project, Chapman said.
“Ultimately, we want to figure out if we can create an intervention that really makes a difference,” she said. “People who study implicit bias have figured out how to measure it and to demonstrate that it exists. So, what we’re doing is taking all of this great scholarship that’s been done and applying it. And that’s exactly what social work intervention research is all about. We should be saying, ‘Ok, what do we do with this knowledge, and how can we create and test an intervention to solve a problem?’ ”
If the intervention is successful, Chapman and her colleagues hope to replicate it with different health settings and for different populations. Long-term, the associate professor is also optimistic about the potential to develop other joint studies across disciplines.
“This study really brings together a very exciting team and a variety of expertise that it takes to solve complex problems,” she said. “I don’t know how often something like this happens, but it’s also a tertiary aim of the project to figure out how to bring people together in this trans-disciplinary way and to really work collaboratively. So, hopefully, we’re creating kind of a model for bringing together all of these perspectives from across campus.”