Healthcare at the Microsystem Level

Delivering healthcare to underserved communities by identifying social determinants and educating students

If small communities can develop a trusting relationship with healthcare providers and vice versa, people will be prone to seek care more consistently, maintaining stable health instead of risking Emergency Room visits. Having small, microsystem health centers that are embedded in the community promotes trust, making people feel more comfortable when it comes to seeking and receiving healthcare services. Dr. Cindy Sickora, Associate Professor and Founding Director of the Jordan and Harris Community Health Center at Rutgers School of Nursing, is bringing high-quality, culturally competent care to underserved urban communities. By studying methods of improving health outcomes for a population that suffers from health disparities as well as extreme poverty, Dr. Sickora hopes to demonstrate: 1) how we can improve lives; 2) how we can deliver healthcare in a cost effective and culturally relevant manner; and 3) how to train students to work more efficiently and effectively as teams in partnership with patients.

With a team of community health workers, registered nurses, advanced practice nurses, a physician and students from multiple disciplines, Dr. Sickora and her team deliver healthcare services in public housing developments in the city of Newark, NJ, where residents live in extreme poverty and have very poor health outcomes. Employing community health workers from within the neighborhood, the program is not only demonstrating the efficacy of providing healthcare onsite, but also building trust and empowering the community to participate by developing relevant programs and becoming part of the solution. By looking at metrics in the number of annual ER visits, blood pressure, blood sugar levels, and asthma management, Dr. Sickora has shown that microsystem healthcare delivery has reduced the number of ER visits and yielded improved health and social outcomes. She also continues to study the impact of community empowerment, healthcare interventions and violence prevention. Interprofessional student education teaches the next generation of healthcare providers the social determinants of health and the importance of partnering with patients in order to address complex health issues.

The team has been focusing on a number of projects that study the impact of the team’s delivery model on very specific outcomes:

  • Improving management of chronic diseases: Dr. Sickora and her team are in the early phases of demonstrating their model’s impact on hypertension, such as high blood pressure, and diabetic management. Eventually, she also hopes to study her model’s effects on asthma management.
  • Improving vaccine rates in children under the age of 2: Newark, NJ has historically had very low vaccination rates. The Jordan and Harris Community Health Center addresses the need for childhood vaccination by reaching out to every household in the housing developments served by the program.
  • Addressing the issue of obesity and exercise: Dr. Sickora is studying obesity in the context of heart disease, diabetes and chronic illnesses, and works to strengthen exercise programs for children and adults. For example, she is currently collaborating with a professor who studies the impacts of Wii on exercise in the population. As many community members choose to exercise by strolling through the neighborhood, safety becomes another social determinant of health, and Dr. Sickora examines these determinants to create programs that will best serve the needs of the community.
  • Identifying methods of delivering mental health services: Delivering health services to a population that suffers from mental health issues but has difficulty accepting mental health services can be challenging. Therefore, Dr. Sickora and her team are looking at various social determinants like alcohol and substance abuse, and depression to prevent and treat mental health issues.
  • Addressing issues of violence as a public health concern by working with women before pregnancy: With the long-term goal of improving parenting skills, Dr. Sickora hires community health workers specifically for maternal-child program and provides specific training for them in counseling and prenatal care. By “mothering” the mother, the program hopes to improve parenting skills and impact the holistic parent-child experience.


As an associate professor at the Rutgers School of Nursing, Dr. Cindy Sickora is passionate about bringing high-quality, culturally competent care to underserved urban communities. She is also dedicated to teaching health professionals how to identify community need and conceptualize approaches to care in partnership with the communities served. This is particularly important in marginalized communities where health disparities are most prevalent. Finally, she believes that nurses have a great deal to offer to healthcare reform: drawing on the deep roots in community nursing, Dr. Sickora and her team are uniquely situated to offer low cost, innovative primary care.

Although Dr. Sickora never intended to become a researcher, she has always wanted to deliver healthcare to an underserved, marginalized, disenfranchised population and to develop a sustainable model of healthcare delivery that would change health outcomes for the population. She believed, and still does, that empowering people to participate in decision-making is critical to the process of change and that healthcare must be delivered in a way that has cultural relevance and sensitivity.

She also believes that if we are to change healthcare delivery, we must educate a healthcare workforce that can work as a team with other healthcare providers and the patient as equal partners in the process. Care needs to be delivered at the microsystem level with an understanding of the social determinants of health.

As she developed this model of microsystem healthcare delivery, she found that in order to sustain the model, she must demonstrate its effectiveness. That is when she became a researcher and the reason why she continues to study the impact of her model on health and social outcomes today.

Outside of her research, Dr. Sickora enjoys spending time at the beach, gardening, and spending time with her children.

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Lester Z. Lieberman Leadership Award, 2014

Healthcare Foundation of New Jersey (HFNJ)

Lester Z. Lieberman Humanism in Healthcare Award, 2010

Healthcare Foundation of New Jersey (HFNJ)

Sigma Theta Tau Community Health Award, 2009

NJDHSS, Excellence in Nursing, 2003