Results of a Voter Registration Project at 2 Family Medicine Residency Clinics in the Bronx, New York

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Voter registration was conducted at the Williamsbridge Family Practice and the Family Health Center, 2 FQHCs in the Bronx, New York. These sites serve as medical student, family medicine residency, and faculty practice sites for the Department of Family and Social Medicine at Montefiore Medical Center/Albert Einstein College of Medicine. A unique aspect of the department’s residency curriculum addresses social justice and health disparities.¹³ The clinics are managed in collaboration with the Bronx Community Health Network, a community advocacy and service organization.

The clinics are located in different communities in the Bronx, but the demographic makeup of the 2 communities is largely similar. Seventy-eight percent of Williamsbridge Family Practice and 79% of Family Health Center community residents self-identify as black or Latino, 33% and 35% are foreign-born, and 55% and 64% have at most a high school education, respectively. The Family Health Center community is somewhat more impoverished, with 33% of residents living at or below the poverty line, compared with 16% in the Williamsbridge Family Practice community.^14,15

Procedures

Voter registration took place from August 1 to October 12, 2012. The project was implemented in 3 phases: administrative approval, volunteer recruitment and training, and voter registration. We obtained approval for this project after meeting with clinic and hospital leadership over several months. In these discussions, we highlighted the role of community health centers as federally supported locations to conduct voter registration. We also stressed the importance of using clinics to address disparities in civic participation, a powerful social determinant of health.

Clinic staff, nurses, physicians, Bronx Community Health Network community board members, and Bronx area college students were recruited as volunteers. Two Bronx area college students and 2 Department of Family and Social Medicine resident physicians spearheaded the effort. Volunteers attended a 2-hour training session conducted after-hours by the National League of Women Voters. The training covered voter registration rules and eligibility. Twenty volunteers were recruited in total: 13 provided basic information to potential voters, and 8 received an additional hour of training to answer patient questions and register them to vote. Of the 8 volunteers with special training, 2 were students, 2 were resident physicians, 2 were attending physicians, and 2 were clinic staff. Volunteer time varied from 3 to 8 hours weekly and volunteers staffed 50% of the clinic sessions.

We developed a 3-pronged strategy to efficiently register patients to vote as part of the regularly scheduled clinic visit: direct engagement with patients by volunteers, education about voting laws in New York, and voter registration. Patient-volunteer interactions took place at all areas of the patient flow: during waiting times in common areas, during appointment registration, when vital signs were taken, and before or after the physician encounter in the examination room. Voter registration took an average of 5 to 7 minutes to complete. It was conducted in a nonpartisan manner and patients were not instructed on candidates’ positions.

Patients were asked if they were interested in learning more about voting as part of a clinic-driven voter registration effort. If they expressed interest, they were referred to a specially trained volunteer who could answer questions regarding incarceration, citizenship, language and disability barriers, and changes in name or address as they pertain to voting. Volunteers then administered a 2-minute questionnaire to collect patient demographics and assessed voting eligibility using the New York City Board of Elections criteria (Supplemental Appendix 1). Patients were considered eligible if they would be 18 years or older at the time of the presidential election, were US citizens, and were not on parole for a felony conviction. Patients were asked their age and sex, if they had ever voted in the past, and if they had changed their name or address since the last election in which they voted. If patients were eligible and agreed to register, they were given a voter registration card to complete on site. All completed registration cards were mailed to the Board of Elections on behalf of the patient, or mailed by the patient. Patients were told to expect mail correspondence from the Board of Elections regarding their polling location, and voting day policies and procedures. Both eligible and ineligible patients were given written materials that included information for voters and political party platforms, and charged to spread the word about voting in their community (Supplemental Appendixes 2 and 3).

The primary outcomes of the intervention were voter engagement through patient-volunteer interactions and voter registration. Patients were considered to have engaged with volunteers if they agreed to speak with a volunteer about voter registration. They were considered to have registered to vote if they were eligible and either accepted a voter registration card with the intent to complete it or completed a card on site. Descriptive statistics of aggregate data were reported for this project.

The Committee on Clinical Investigation at Albert Einstein College of Medicine approved this project.