Combating Cambodian Health Disparities Three Decades After Genocide: Building Community Capacity

Background and Purpose: Cambodian Americans have high rates of chronic health problems and are at disproportionately greater risk for death from diabetes and cardiovascular disease than the general U.S. population. This study aimed to build the research capacity of Cambodian communities across the U.S. and assessed the feasibility and effectiveness of training Cambodian community health workers (CHWs) to use mobile technology to identify community health concerns.

Methods: A community based participatory research approach was utilized to engage six Cambodian community leaders to identify their research needs, develop and conduct a community survey using mobile technology, and analyze the findings. A non-experimental design was employed. Cambodian CHWs collected survey data from a convenience sample of 371 Cambodian community members aged 18 to 88 in six states using handheld tablets programmed in spoken Khmer. The sample was matched to the 2010 gender/age census distribution. The survey included the Cantril self-anchoring scale to assess community wellbeing, a single-item general health status question, and questions to assess areas of concern specific to Cambodians. Feasibility and effectiveness was assessed through anonymous surveys of CHWs and leaders and analysis of study training and supervision logs. Analysis included descriptive statistics and generalized linear mixed models (ordinal logistic regressions with a random effect for site).

Results: It was feasible and effective to train Cambodian CHWs to collect data using iPads. Community members found the spoken Khmer format “very easy” to understand (61%) and liked using the iPad “very much” (86%). It was important to have tech support available due to: 3G/4G connectivity challenges and occasional freezing of the iPads. Survey participants perceived the health of their community to be fair and 84% expressed concern about homebound community members. Participants indicated that Cambodian CHWs are “quite important” for their health and 45% stated that they would have nowhere to go for help if there were no Cambodian organizations in their community. Forty-two percent reported either that they did not have a right to an interpreter or did not know if they had a right to an interpreter when they see a doctor. Women were significantly more likely to report a lower quality of life. Barriers to accessing health care included: language barriers (82%), cost/lack of health insurance (69%), transportation problems (68%), not being in the habit of getting annual health check-ups (53%), and fearing that the doctor may find something wrong with them (53%). Significant predictors of the perceived health of the community included: perception of own general health, perception of their own quality of life, # of ER visits, worry about shut-ins, and knowing you have a right to an interpreter.

Conclusions and Implications: This study contributed to building the research capacity of Cambodian community-based organizations and demonstrated that Cambodian CHWs can be trained to collect data about the health of their community using handheld technology. Cambodian community leaders are collaborating in the dissemination of the study findings and using the results to plan for further research and services to address the health disparities of Cambodians in America.