This new coalition will unite UCSF, BCH Oakland, SF General, and other partners to advance Integrative Pediatrics with a focus on equity and community-building. Each quarterly event will rotate among UCSF-affiliated sites, targeting primary care physicians and advanced practice practitioners, social workers, behavioral health providers, and outpatient clinical staff. Events will include integrative care seminars on climate change, environmental justice, and access to integrative care, alongside product selection sessions to support safe, informed clinical practice. The quarterly coalition meetings could build towards a dedicated day-long advocacy retreat, empowering the coaliition to drive impactful initiatives in health equity and integrative pediatrics.

Budget: Total budget estimate of $15,000 to include honorariums/teaching stipends, supplies, catering, marketing. 

Project Title: Pathways to Health Equity: Training in Herbal Medicine and Integrative Practices 

Project Title: Filling in the Gaps: An Assessment of Food Pantry Meal Kit Feasibility 

Names of Project Lead(s) and Key Team Members: Danica Cowan, Bree Phillips, Linda Dulong

Food insecurity is a significant barrier to integrative health equity.  Nutrition is a key component of integrative care, but it is nearly impossible to implement if patients don’t have access to healthy food.  When patients have access to food banks and other forms of food assistance, individuals often do not have the knowledge, skills, or resources to turn pantry items into nourishing meals.

With this proposal we hope to bridge the gap between pantry and plate.  We have many ideas about what those gaps might be, but our first step would be to ask patients what they need.  Our first deliverable would be to connect with food assistance nonprofits (we have several pending potential connections–SF Marin Food Bank, UCSF Food Pharmacy, Project Open Hand, and others)  Identifying further food assistance, nutrition education, and culinary medicine nonprofits would be a secondary deliverable.  This would be distributed to both UCSF nutrition professionals, as well as to all the surveyed nonprofits. There are so many organizations out there doing great work in the community, but they can be hard to find and aren't well known to nutrition providers or to each other. These nonprofits would distribute our surveys to their individual participants. In parallel we could screen our patients for food insecurity and provide surveys to them as well.  

After identifying partners and distributing and analyzing surveys we would move into phase 2: filling the gaps.  Depending on survey results, we would create or curate a budget-friendly, culturally appropriate recipe library.  This recipe library would be distributed to nonprofit partners, and could be used by our Osher communications team for patient education and nonprofit and marketing purposes.  If culinary skills are identified as a gap, further resources could be created (or curated if they already exist), such as educational videos (knife skill demos, etc), which could also be used by Osher communications. 

If ingredients are identified as a gap, we could build partnerships with local businesses.  For sintace, we anticipate spices and cooking oils may be limiting ingredients, and we could build partnerships with local spice shops and zero waste grocery stores, who could distribute small, customized amounts of ingredients.  If kitchen equipment is identified as a barrier, we could connect to local BuyNothing groups to solicit donations of items like pops, pans, blenders, or slow cookers.  (see BuyNothingProject.org/about to learn more about the BuyNothing movement) 

There are many innovative and sustainable aspects to this project.  By making connections among community organizations we are increasing access and efficiency, and avoiding reinventing the wheel, and promoting integrative health equity not just our patients at UCSF, but in the community at large.

Budget Estimate: Total budget estimate $15,000 to include recipe development, resource procurement, and additional food ingredients

Names of Project Lead(s) and Key Team Members

Joanne Qinaʻau, PhD, MA, T32 Postdoctoral Fellow, Lead

Maria Chao, DrPH, MPA, Director of Research, Advisor

Marliese Warren, MS, Integrative Health Equity Program Manager, Collaborator

Initial Proposed Timeline

January – February: Development of survey and interview materials

• Develop interview and survey questions to gather data to optimize acceptability and feasibility of future curriculum.
• Map out dissemination for surveys (e.g., engage collaborators to brainstorm mediums for surveys such as QR codes in restrooms, newsletters, email lists, flyers, etc.)
• Identify interview participants.

March – April: Gather data

• Launch survey across multiple dissemination arms.
• Conduct interviews on Zoom and through email.

May – June: Analysis and sharing of data

• Analyze data.
• Share results.

July – September: Curriculum design and review

• Create initial curriculum based on literature review of similar programs, data gathered from surveys and interviews, and best practices in mindfulness program adaptation (e.g., Loucks et al., 2023).
• Receive feedback from collaborators and interested participants who opted in regarding curriculum development.
• Revise curriculum design.

September – October: Curriculum element testing

• Test run aspects of curriculum in presently standing meetings to optimize accessibility.

November: Reporting

• Prepare and deliver report.

Project Description: A feasible collaboration with potential for sustainable impact

As a safe and effective integrative approach, mindfulness based interventions (MBIs) can be feasibly incorporated into advanced healthcare disciplines (Praissman, 2008; H. Williams et al., 2015). The MBI offered will be trauma sensitive (Treleaven, 2018) and adapted to optimize acceptability and feasibility. Data elicited from providers, staff, and trainees at UCSF Osher Center will inform implementation and content. To ensure beneficial impact in the short- and long-term, the program emphasizes implicit bias reduction using mechanism evidence from the literature (e.g., reducing stress and burnout, increasing awareness and compassion, and enhancing cultural sensitivity). The program will be designed based on feedback from interviewees and survey participants, as well as the extant literature. The beneficial impacts on integrative health equity are likely to be long term, as positive effects of mindfulness interventions can persist for at least one year post-intervention (Cascales‐Pérez et al., 2021; Geary & Rosenthal, 2011). The program will emphasize community building and resource sharing beyond the live program. Other possibilities include recorded sessions and ongoing practice sessions.

Significance and innovation

While other MBSR programs exist at the Osher Center and in the UCSF system, this program is innovative in that it: 1) focuses on providers, staff, and trainees; 2) will be designed to reduce implicit bias based on empirical evidence; and 3) will be adapted for the specific Osher Center context.

The literature highlights implicit bias among healthcare providers towards minorities and stigmatized groups (FitzGerald & Hurst, 2017; Maina et al., 2018; Zestcott et al., 2016). These biases pose challenges to integrative health equity, leading to disparities in care (Chapman et al., 2013; Phelan et al., 2015). Since healthcare professionals exhibit similar bias levels as the general population (FitzGerald & Hurst, 2017), such bias likely exists at the Osher Center.

Mindfulness-based interventions (MBIs) provide promising approaches to reduce biases and promote health equity (Burgess et al., 2017; Woods-Giscombe & Giscombe, 2022). Mindfulness training will improve self-awareness, therapeutic communication, and cultural sensitivity during provider-patient interactions which then supports providers (and staff) in identifying their use of stereotypes when working with diverse patients (Woods-Giscombe & Giscombe, 2022). Meta-analyses show effects of mindfulness on reducing bias & biased outcomes (Chang et al., 2023; Oyler et al., 2021). Even brief mindfulness can diminish linguistic intergroup bias (Tincher et al., 2016), alleviate stress, and reduce implicit biases in healthcare professionals (Murphy et al., 2023). MBIs reduce bias activation, increase awareness and control of biases, and enhance compassion (Burgess et al., 2017). Additionally, MBSR supports health equity indirectly by reducing stress and burnout for medical students (Hathaisaard et al., 2022; Polle & Gair, 2021) and improving quality of life and self-compassion in healthcare professionals (Shapiro et al., 2005). MBIs demonstrate effectiveness in decreasing psychological distress and medical symptoms (K. A. Williams et al., 2001), indirect barriers to equity.

Given the inclusion of providers and staff, the resulting curriculum has the potential to not only improve individual outcomes, but has the potential to shape the culture of equity, wellbeing, and awareness of bias at the social and structural levels at the center.

Personnel

Jo Qinaʻau, PhD, MA is a postdoctoral research fellow at the Osher Center. She is responsible for overseeing the successful execution of the proposed project including survey design, administration, analysis; interview design, administration, analysis; reporting; curriculum design; initial testing of curriculum. We request support for 10% effort for her contributions to the project.

Marliese Warren, MS, is the Integrative Health Equity Program Manager at the Osher Center.Shewill collaborate with Dr. Qina’au to identify barriers to staff participation in bias trainings and other DEI-focused work; develop strategies to support participation and increase engagement; and provide input on curriculum development. We request support for 2.5% effort for her contributions to the project.

Maria Chao, DrPH, MPA is Director of Research and Associate Director for Health Equity and Diversity at the UCSF Osher Center for Integrative Health. Dr. Chao will be available on an as-needed basis to advise on all aspects of the project. No salary support is requested.

References

Burgess, D. J., Beach, M. C., & Saha, S. (2017). Mindfulness practice: A promising approach to reducing the effects of clinician implicit bias on patients. Patient Education and Counseling, 100(2), 372–376.  https://doi.org/10.1016/j.pec.2016.09.005

Cascales‐Pérez, M. L., Ferrer‐Cascales, R., Fernández‐Alcántara, M., & Cabañero‐Martínez, M. J. (2021). Effects of a mindfulness‐based programme on the health‐ and work‐related quality of life of healthcare professionals. Scandinavian Journal of Caring Sciences, 35(3), 881–891.https://doi.org/10.1111/scs.12905

Chang, D., Donald, J. N., Whitney, J., Miao, I., & Sahdra, B. K. (2023). Does Mindfulness Improve Intergroup Bias, Internalized Bias, and Anti- Bias Outcomes?: A Meta-Analysis of the Evidence and Agenda for Future Research. Personality and Social Psychology Bulletin.https://doi.org/10.1177/01461672231178518

Chapman, E. N., Kaatz, A., & Carnes, M. (2013). Physicians and implicit bias: How doctors may unwittingly perpetuate health care disparities. Journal of General Internal Medicine, 28, 1504–1510.

Dovidio, J. F. (2016). Racial biases in medicine and healthcare disparities. TPM - Testing, Psychometrics, Methodology in Applied Psychology, 1, 489–510. https://doi.org/10.4473/TPM23.4.5

FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1). https://doi.org/10.1186/s12910-017-0179-8

Geary, C., & Rosenthal, S. L. (2011). Sustained Impact of MBSR on Stress, Well-Being, and Daily Spiritual Experiences for 1 Year in Academic Health Care Employees. The Journal of Alternative and Complementary Medicine, 17(10), 939–944. https://doi.org/10.1089/acm.2010.0335

Hathaisaard, C., Wannarit, K., & Pattanaseri, K. (2022). Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis. Asian Journal of Psychiatry, 69, 102997.

Maina, I. W., Belton, T. D., Ginzberg, S., Singh, A., & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare provide rs using the implicit association test. Social Science & Medicine, 199, 219–229. https://doi.org/10.1016/j.socscimed.2017.05.009

Murphy, J., Farrell, K., Kealy, M. B., & Kristiniak, S. (2023). Mindfulness as a self-care strategy for healthcare professionals to re duce stress and implicit bias. Journal of Interprofessional Education & Practice, 30, 100598. https://doi.org/10.1016/j.xjep.2022.100598

Oyler, D., Price-Blackshear, M. A., Pratscher, S. D., & Bettencourt, B. (2021). Mindfulness and intergroup bias: A systematic review. Group Processes & Intergroup Relations. https://doi.org/10.1177/1368430220978694

Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. https://doi.org/10.1111/obr.12266

Polle, E., & Gair, J. (2021). Mindfulness-based stress reduction for medical students: A narrative r eview. Canadian Medical Education Journal. https://doi.org/10.36834/cmej.68406

Praissman, S. (2008). Mindfulness‐based stress reduction: A literature review and clinician’ s guide. Journal of the American Academy of Nurse Practitioners, 20(4), 212–216. https://doi.org/10.1111/j.1745-7599.2008.00306.x

Shapiro, S. L., Astin, J. A., Bishop, S. R., & Cordova, M. (2005). Mindfulness-Based Stress Reduction for Health Care Professionals: Results From a Randomized Trial. International Journal of Stress Management, 12(2), 164–176. https://doi.org/10.1037/1072-5245.12.2.164

Tincher, M. M., Lebois, L. A., & Barsalou, L. W. (2016). Mindful attention reduces linguistic intergroup bias. Mindfulness, 7(2), 349–360.

Treleaven, D. A. (2018). Trauma-sensitive mindfulness: Practices for safe and transformative healing. WW Norton & Company.

Williams, H., Simmons, L. A., & Tanabe, P. (2015). Mindfulness-Based Stress Reduction in Advanced Nursing Practice. Journal of Holistic Nursing, 33(3), 247–259. https://doi.org/10.1177/0898010115569349

Williams, K. A., Kolar, M. M., Reger, B. E., & Pearson, J. C. (2001). Evaluation of a Wellness-Based Mindfulness Stress Reduction Interventi on: A Controlled Trial. American Journal of Health Promotion, 15(6), 422–432. https://doi.org/10.4278/0890-1171-15.6.422

Woods-Giscombe, C. L., & Giscombe, K. K. (2022). Mindfulness Training for Healthcare Providers and Healthcare Systems. In Beyond White Mindfulness (pp. 153–166). Routledge; https://doi.org/10.4324/9781003090922-13

Zestcott, C. A., Blair, I. V., & Stone, J. (2016). Examining the presence, consequences, and reduction of implicit bias i n health care: A narrative review. Group Processes & Intergroup Relations, 19(4), 528–542. https://doi.org/10.1177/1368430216642029

Twelve percent of Latinx patients, including 3.7% of monolingual Spanish speakers receive care at UCSF’s Cancer Center with limited language concordant and multicultural support. S.U.P.E.R.A. is a virtual Spanish Skills Group Medical Visit (GMV) that is being developed in the Psycho-Oncology department in collaboration with faculty in the OCIH. This initiative leverages evidence-based cognitive behavioral interventions to assist Spanish-speaking cancer patients in navigating active treatment. This project aims to refine and optimize this new GMV via a QI pilot to assess need, explore engagement, and ensure group content is culturally and linguistically relevant in its delivery. This data will lay the groundwork for future research that will investigate effectiveness in reducing emotional and psychological distress and the adoption of evidence-based coping strategies in an underrepresented Latinx population. This initiative will improve integrative health equity by exploring culturally specific needs, increase access to quality mental health care, and expand Spanish language programming.

Budget: Total budget estimates of 15,000 to 20,000 to cover personnel expenses (i.e., research time, study coordination, statistician support) and future conference presentation stipend.