MILESTONE 1 1

Milestone 1: Report of Initial Literature Search and Question Development

Ruby Guevara and Adriana Turtura

School of Occupational Therapy, Pacific Northwest University

OTH 540: Foundations of Inquiry II

Dr. Malcolm Cutchin

January 23, 2024

MILESTONE 1 2

Milestone 1: Report of Initial Literature Search and Question Development

Part I

Mexican Americans are at higher risk than the general population for the development of

multiple chronic diseases, such as diabetes, hypertension, obesity, and depression. Our question,

“What is the relationship between social determinants of health (SDOH) and the health outcomes

of first-generation Mexican American aging adults?”, aims to identify and define the multiple

social determinants of health that contribute to chronic disease in Mexican Americans. A

significant portion of Yakima Valley Farm Workers Clinic's patients are Mexican American

aging adults, so it is imperative to understand the social and environmental factors that impact

health outcomes in this community.

Part II

Population: First-generation Latino aging adults

Exposure: Lack of access to preventative and quality healthcare

Outcome: Identify the social and environmental barriers that are restricting access to quality

health care among the aging Mexican American population to help improve health outcomes

among this vulnerable population.

Using the PEO model rather than the PICO model proved to be more appropriate for us

because the exposure’s effect must be studied before an effective intervention can be developed.

Furthermore, our partnership with Yakima Valley Farm Workers Clinic does not allow for

clinical studies currently. After we determined that PEO was the most appropriate model for our

available data and research goals, we began to search the literature for information regarding the

population, exposure, and outcomes we were investigating. Initially, our search yielded very little
MILESTONE 1 3

regarding the roles of adverse SDOH and related health outcomes for the aging Mexican

American population.

Part III

The initial electronic search was carried out using online databases, PubMed and

CINAHL, to identify the environmental factors and social determinants of health (SDOH) that

put first-generation Mexican Americans at higher risk than the general population of developing

multiple chronic diseases. Keywords searched were ‘occupational therapy’, ‘chronic medical

conditions’, ‘chronic disease’, ‘first-generation Mexican Americans’, ‘farmworkers’, ‘social

determinants of health’, ‘medically uninsured’, ‘aging’, and ‘geriatric’. The search was

disappointing because it turned up very few articles that specifically addressed SDOH

concerning the aging population. We considered changing our research question; however, Dr.

Fritz helped us realize it was our search methods that needed changing. She pointed out that

people don’t just wake up one day old and sick. She told us that SDOHs are like adverse

childhood experiences (ACEs) in that they are manifested over the life course and the

accumulation of them can predict the shortening of one’s lifespan. Guided by the concept of

cumulative inequity, we revised our search accordingly.

Part IV

Our first search only produced articles that confirmed Mexican Americans are more

likely to develop multiple chronic diseases compared to their white counterparts. In addition to

access to affordable health services, we broadened our second search to include the financial,

structural, and cognitive barriers to care between Mexican American adults with and without

comorbidities. Keywords searched were: ‘diabetes mellitus, Type 2’, ‘cardiovascular diseases’,

‘hypertension’, ‘hypercholesterolemia’, ‘comorbidity’, ‘physical function’, ‘cultural

characteristics’, ‘Hispanic’, ‘ethnicity’, ‘environment’, ‘social environment’, ‘social sciences’,

MILESTONE 1 4

‘health knowledge’, ‘health services accessibility’, ‘health status disparities’, and ‘risk

assessment’. Adding keywords to the second search that reflected specific chronic conditions,

and specific barriers to adequate healthcare painted a more thorough picture of the layers and

complexities of the inequities that contribute to Mexican Americans’ higher risk of developing

multiple chronic diseases. Modifying the search also provided insight into how to assess the

unique needs of the Mexican American community and tailor interventions to address specific

SDOH affecting this community.

Part V

As we continued to dig, more questions came to mind. In addition to identifying the

social and environmental factors contributing to chronic disease among aging Mexican

Americans, we are now curious about OT interventions at the population level, and which are

most effective for decreasing health disparities in this vulnerable population. Also, how can

intrinsic motivation for better health outcomes be best achieved in this population? The

broadening of our search also broadened our curiosity. There is a notable gap in the literature

regarding occupational therapy’s specific role in addressing SDOH. We would like to address

that gap, but are not entirely sure how to do so, or if it is even appropriate to do so within the

context of this assignment. For now, we have tweaked our question to reflect our curiosity to:

What are the social and environmental factors contributing to chronic disease among aging

Mexican Americans, and how can occupational therapy mitigate these factors?

Part VI

It’s still early days for question development. More guidance from Dr. Fritz is needed to

further refine our research question and confirm that it aligns with the data she will be able to

provide. We’ve scheduled to meet with her on Monday, January 29th. With her help, we will
MILESTONE 1 5

focus our search and begin to build our literature matrix. So far, we have a dozen peer-reviewed

journal articles that we believe will prove useful. Our goal in the coming week is to do a deep

dive into the gray literature. We hope that in doing so, we will better understand the multiple

levels of relationships between individuals and their environments.