Partnering With the African American Community to Curb COPD

By: Lorriane Odhiambo, PhD, MPH

February 23, 2023

Chronic obstructive pulmonary disease (COPD) is a poorly diagnosed respiratory condition. Globally, millions of people are unaware they have the disease, while others are misdiagnosed in clinical settings (Centers for Disease Control and Prevention. Accessed February 2023). Each year, as many as 150,000 Americans succumb to COPD. This is partly due to late diagnosis and use of inappropriate therapies in misdiagnosed patients. Efforts to overcome delays in diagnosis are pertinent to improving quality of life in patients and reducing premature mortality.

Burden of COPD Among Black Americans

Over the last two decades, Black Americans have had the least decline (0.7)* in COPD mortality compared with White Americans (5.5) and Hispanic Americans (4.5) (American Lung Association. Accessed February 2023). The poorer outcomes among Black Americans are linked to low socioeconomic status, inadequate health insurance coverage, and other social determinants of health. Black Americans are less likely than White Americans to be referred to smoking cessation programs and to get diagnosed with COPD when they have the disease (Am J Respir Crit Care Med. 2019;200[4]:423-430). Rates are lower in Black Americans for influenza and pneumonia vaccines, both of which are recommended for management of COPD. Furthermore, the representation of Black patients in COPD research studies remains a challenge.

*Rate per 100,000 persons

Community-Based Efforts for COPD

Academic-community partnerships that engage community members as partners have been established as one approach to addressing health disparities. Community-based participatory research principles are key to such partnership efforts. Collaborative, equitable, and empowering partnerships that promote shared decision-making help cultivate trust, which is crucial to successful implementation of interventions in community settings. The intent is to counter factors that contribute to historical mistrust of health providers, the health care system, and the academic research community. For example, churches and barbershops are used as access points for health promotion on issues that disproportionately affect Black Americans. Through our CHEST Foundation Community Service Grant Honoring D. Robert McCaffree, MD, Master FCCP, Advancing Respiratory Health Equity Through Community-Based Efforts for COPD, we partner with Black American churches to facilitate early diagnosis of COPD in the Augusta, Georgia, community.

Our Project

Existing relationships between one of our pulmonary clinicians and three local churches helped us establish partnerships for this project. As a member of one of the churches, she is motivated to facilitate access to care for her community with support from the Church Health Ministry (CHM). The CHM is an established ministry in most Black American churches that strives to help close the gap in meeting the health care needs of their communities. Together with church leadership and CHMs in each congregation, we will promote early diagnosis of COPD at health fairs to be hosted at the churches. Prior to the fairs, a COPD educator will train church representatives identified by church leadership. This training will cover COPD knowledge and management and use of the COPD-Population Screener (COPD-PS), a publicly available symptom-based tool used to prescreen for COPD. The representatives will become our COPD liaisons in the implementation of the two-step case-finding approach used to diagnose COPD.

At the health fairs, the liaisons will administer and score the COPD-PS (step one), while our team of pulmonary clinicians and respiratory therapists will perform pulmonary function tests (PFTs) for church members who score >5 on the COPD-PS (step two). Our team will also facilitate appropriate follow-up and linkage to resources based on PFTs and smoking status, including referral to the recently opened COPD clinic at the Medical College of Georgia. We will administer COPD knowledge and self-efficacy surveys among the liaisons as part of evaluation. Process measures related to stakeholder engagement and the quality of partnerships formed will also be monitored.

Findings from similar events hosted in Akron, Ohio, informed our decision to complete both steps on the same day and to promote the event as part of a general health fair offering other screenings and health-related services (J Immigr Minor Health. 2022;1-9). In future efforts, trained COPD liaisons could administer the COPD-PS at routine church health fairs and make appropriate informal referrals to local providers. This could encourage deliberate conversations with providers about COPD symptoms, which are often underreported. In this regard, the liaisons serve as advocates in improving health-seeking behavior and patient-provider communication.

Intervention strategies that resonate with the community and are adoptable into the existing environment can create opportunities of significant impact with partners already trusted by the people in the community. Historically, Black Americans have often turned to their faith and church community for support and solace to face various challenges. For more than 300 years, churches have been safe havens for most Black Americans in their quest for equality and social justice. Health care projects implemented in such trusted settings are more likely to be effective and sustainable, particularly when existing resources are leveraged.

Closing the gap in COPD health outcomes across racial minority populations requires equitable partnerships between academic researchers, clinicians, and community stakeholders. Training COPD liaisons is an essential part of dissipating disparities and building trust in COPD prevention, diagnosis, and treatment strategies for Black Americans.

Lorriane Odhiambo, PhD, MPH

Dr. Odhiambo is an Assistant Research Scientist in the Institute of Public and Preventive Health at Augusta University. Dr. Odhiambo applies epidemiological methods to inform the development of public health interventions for underserved populations with a disproportionate burden of disease in the United States and across the globe. Her research has focused on identifying and addressing health inequities in the prevention, diagnosis, and self-management of COPD.