Article Figures & Data
Tables
Interviews Neighborhood Tours Clinic Visit Observations Community leaders 10 8 N/A Patients 10 9 4 Health service providers 3 N/A N/A N/A, not applicable; MAVEN, Mapping to Amplify the Vitality of Engaged Neighborhoods.
- Table 2.
Patient, Community Leader, and Health Service Provider Participant Characteristics
Patients (n = 10) Race/Ethnicity Sex Age Group Education Income Neighborhood Black Female 60 to 69 High school Bayview-Hunters Point Black Male 60 to 69 Some college Bayview-Hunters Point White Female 60 to 69 College graduate <$20,000 Tenderloin Asian or Pacific Islander Female 60 to 69 College graduate $20,000-$40,000 Tenderloin Black Female 70 to 79 Graduate degree <$20,000 Western Addition Black Male 50 to 59 Some college <$20,000 Tenderloin Black; Multi-Ethnic Female 60 to 69 Some college <$20,000 Bayview-Hunters Point American Indian/Native American Male 60 to 69 College Degree $20,000-$40,000 Excelsior Black Female 50 to 59 Some college <$20,000 Bayview-Hunters Point & Lakeshore Hispanic/Latinx Female 40 to 49 Graduate degree <$20,000 Tenderloin Community Leaders (n = 10) Role Organization Description Neighborhood Librarians (2) Public library with a robust health programming/collection Tenderloin Patient Advocate Coordination department for patient advisory councils at public health clinics Tenderloin Staff leader Health and wellness organization serving primarily Black communities Bayview-Hunters Point Staff leader Nonprofit cooking school serving low-income communities Mission Senior services, resources, and activities staff (3) Social services organization serving low-income seniors, youth, and families of color Mission Staff leader Social services organization serving low-income multi-ethnic families with young children Excelsior/Visitacion Valley, Mission Former staff Leader Latinx cultural organization Mission Health Service Providers (n = 3) Role Role Description Neighborhood Diabetes nurse educator Nurse educator and diabetes educator for patients in a public healthcare delivery system San Francisco (city-wide) Primary care physician Physician; Health services researcher San Francisco (city-wide) Primary care physician Internist in a public healthcare delivery system; Health services researcher San Francisco (city-wide) N/A, not applicable.
- Table 3.
Types and Attributes of Neighborhood Resources Related to Chronic Disease Management Identified in Patient and Community Leader Interviews and Tours
Resource Category Attribute/Specific Examples FOOD Price, quality, and availability of food for purchase (grocery stores, restaurants, food pantries, food assistance programs, farmer's markets, free meals programs) Patient 3 identified a social service agency that provides food tailored to diabetes-related dietary restrictions. Patient 7 explained that a grocery store is often messy and its prices can be twice the price of stores in other neighborhoods. Free groceries and meals Patient 1 noted that a church hands out free produce once a week. PUBLIC SPACE/RECREATIONAL PLACES Places where people congregate (community gardens, public parks, libraries, pools, playgrounds, community and senior centers) Patient 4 explained that there are activities for seniors in a park and a nearby area recently had a free health fair. Safety Patient 3 mentioned avoiding certain streets due to gun violence. Accessibility of public spaces Patient 2 identified a church as being handicap accessible. HEALTH Types and availability of local health services and programs (healthcare facilities, community health centers, pharmacies) Patient 1 explained how much she loved her diabetes education class. Patient 3 noted that it takes her a long time to get to her primary care clinic by bus. Specific services that can be requested at local clinics and pharmacies Patient 2 discussed how his pharmacy delivers medications with clear instructions. SOCIAL SERVICES Availability and accessibility of social services (legal representation, mental health services, cultural resources, nutrition programs, access to government identification, homelessness programs) Community leader 10 pointed out a family resource center. Free services available for vulnerable populations Community leader 5 explained that a social services agency hosts free computer classes, a needle exchange and gives out free phones. Patient 6 described a social services agency where he can get free socks helpful for his diabetes-related foot problems. EDUCATION Availability of child-focused programs (schools, afterschool programs, libraries, city colleges, education initiatives) Community leader 10 described an organization that provides culturally relevant services to low-income youth. Learning opportunities for adults Patient 6 described going to the public library to learn about health and meet people. TRANSPORTATION Service quality, accessibility, and reliability of bus lines (public transportation, paratransit, bus/taxi voucher programs) Patient 2 appreciated the reach of the public tram line but also explained that paratransit has long wait times and no same-day requests. Community leader 6 explained that the public tram line does not consistently stop in their neighborhood. HOUSING Housing displacement (affordable housing communities, assisted living facilities, shelters, single residency occupancy hotels) Patient 5 noted many buildings whose Black former owners were pushed out due to redevelopment policies and gentrification. Housing tailored to specific populations Community leader 8 noted a low-income housing community serving residents with special needs. ART Availability of art and cultural events (cultural shows, murals, musical events, museums) Patient 3 explained that a social services agency gives free tickets to the opera, ballet, and sports games. Appreciation of public art Patient 6 noted how much he liked a mural in his neighborhood. - Table 4.
Neighborhood-Level Structural Domains Relevant for Chronic Disease Management Generated by Patients and Community Leaders
Domain Quotes Structural racism “They're dumping waste and garbage… the city has allowed [this] to go on over here [when] they wouldn't allow [it] to go over in Marina Green… Why are you letting it happen here…? Because you figured…it's just poor Black people, why not…? [P]eople are dying, because [they are] right on top of a toxic waste bin.” Patient 7 “[T]his little five-year-old boy…he's having nightmares that he's going to be arrested by the police, at five. If our children are not even feeling not-surveilled at five years old, imagine the anxiety, the depression. Where is he going to feel welcome…?” Community leader 6 “[My two employees] went to the bank…these are black men, [and the bank] would not give them cash until they called for authorization… It's like you don't even have access to your money that you worked for.” Community leader 6 Transportation inequity “If you're an elderly person, you're probably still not going to sit [on the bus] and [you'll] get pushed on. Because of the homelessness issue, there's also the cleanliness issue and it smells… Even if you leave an hour ahead, the bus can totally throw your schedule off and it's also very expensive.” Community leader 5 “Is the [tram] stopping in our area today or is it just going straight through? [F]olks can't actually get here and folks can't get to work on time.” Community leader 6 Housing inequity “[It's the] housing situation, that's why you see a lot more veterans out here, mental health patients, and people that can't keep up paying for rent…you notice that most of the homeless [are] in this demographic area…it's like we're in concentration camp, so to speak.” Patient 4 Gentrification and displacement/residential segregation “But there are…all kinds of people living in all kinds of different neighborhoods that maybe don't have an effect on them. Like someone who's born in the Mission but goes to a private school and has millions of dollars, they don't live in the Mission necessarily the way that someone who was born here and doesn't have those resources.” Community leader 7 “The population of the Mission is probably around 40,000 to 45,000 people. In that 15-year period, the Mission lost 10,000 individuals who were displaced…The 8,000 of those 10,000 were Latinos… It felt like communities are under attack, and it was losing something…” Community leader 11 “I was born and raised here and [this] was a community that was multicultural… A lot of Black and brown families have had to move out due to the re-gentrification…the average income median is what, $140,000? It's a tragedy because [this city is] losing so much of the culture…which made the city unique.” Patient 7 Generational poverty “We may be able to help with barrier removal for a deposit [for housing] but the deposit is not going to do anything for your family…when the rent is 200% more than what you make in a whole month… We're talking about persons who have been impacted by generational poverty. They are already…set up to fail from the beginning.” Community leader 10 Neighborhood safety “This neighborhood is…not healthy… [T]he drug use surrenders on the street…I can hear the noise at night, the shouting and…drug dealing…it's very wearing to have to be constantly alert.” Patient 3
