Community-based participatory research from the margin to the mainstream: are researchers prepared?

Population approaches to improve diet, physical activity, and smoking habits: a scientific statement from the American Heart Association

BACKGROUND

Poor lifestyle behaviors, including suboptimal diet, physical inactivity, and tobacco use, are leading causes of preventable diseases globally. Although even modest population shifts in risk substantially alter health outcomes, the optimal population-level approaches to improve lifestyle are not well established.

METHODS AND RESULTS

For this American Heart Association scientific statement, the writing group systematically reviewed and graded the current scientific evidence for effective population approaches to improve dietary habits, increase physical activity, and reduce tobacco use. Strategies were considered in 6 broad domains: (1) Media and educational campaigns; (2) labeling and consumer information; (3) taxation, subsidies, and other economic incentives; (4) school and workplace approaches; (5) local environmental changes; and (6) direct restrictions and mandates. The writing group also reviewed the potential contributions of healthcare systems and surveillance systems to behavior change efforts. Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified, providing a set of specific evidence-based strategies that deserve close attention and prioritization for wider implementation. Effective interventions included specific approaches in all 6 domains evaluated for improving diet, increasing activity, and reducing tobacco use. The writing group also identified several specific interventions in each of these domains for which current evidence was less robust, as well as other inconsistencies and evidence gaps, informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies.

CONCLUSIONS

This systematic review identified and graded the evidence for a range of population-based strategies to promote lifestyle change. The findings provide a framework for policy makers, advocacy groups, researchers, clinicians, communities, and other stakeholders to understand and implement the most effective approaches. New strategic initiatives and partnerships are needed to translate this evidence into action.

Examining aspects of the built environment: an evaluation of a community walking map project

OBJECTIVE

Interventions that address the built environment present an opportunity to affect behaviours such as physical activity. The purpose of this study was to evaluate a community walking map developed for eight neighbourhoods in the City of Edmonton (COE).

METHOD

A walking map developed in partnership with the COE's Walkable Initiative was distributed to 11,994 households across eight neighbourhoods in July 2010. In total, 149 respondents completed an online follow-up survey that assessed the effectiveness of the walking maps in influencing physical activity.

RESULTS

Of the 149 respondents, 89 (59.7%) reported that they had received a copy of the map, and 60 (40.2%) reported that they had not. Of those who had a copy, 76.4% (n=68) indicated that the routes and destinations on the map encouraged them to walk more in the community, 64.0% (n=57) stated they would walk more often to get to destinations, and 55.1% (n=49) indicated they would walk more often for physical activity or exercise as a result of having a copy of the map. Finally, 91.0% (n=81) stated that they found the map to be useful, as it provided walking routes (60/81, 74.1%,) and places to go in the community (57/81, 70.4%). Of those who did not receive a copy, 95.0% (n=57) indicated that they would use a community walking map.

CONCLUSION

This evaluation demonstrated that a community walking map was a valuable tool for not only encouraging walking for physical activity but also motivating individuals to explore their communities and visit local community destinations.

Clinical and translational research and community engagement: implications for researcher capacity building

This research sought to better understand how clinical and translational research is defined and perceived by community service providers. In addition, the research sought to elicit how the perspectives of service providers may hinder or facilitate collaborative research efforts. The study employed a qualitative methodology, focus groups. A nonprobability sampling strategy was used to recruit participants from three neighborhoods in the Tufts University's catchment area. Focus group findings add to the nascent body of literature on how community partners view clinical and translational research and researchers. Findings indicate that cultural disconnects, between researchers and community partners exist, as does mistrust, all of which serve as potential barriers to community research partnerships. This paper suggests rethinking the business of community engagement in researcher, particularly as it relates to building research capacity to approach, engage, and partner with communities.

"Communities" in community engagement: lessons learned from autism research in South Korea and South Africa

Little research has been conducted on behavioral characteristics of children with autism spectrum disorder (ASD) from diverse cultures within the US, or from countries outside of the US or Europe, with little reliable information yet reported from developing countries. We describe the process used to engage diverse communities in ASD research in two community-based research projects-an epidemiologic investigation of 7- to 12-year olds in South Korea and the Early Autism Project, an ASD detection program for 18- to 36-month-old Zulu-speaking children in South Africa. Despite the differences in wealth between these communities, ASD is underdiagnosed in both settings, and generally not reported in clinical or educational records. Moreover, in both countries, there is low availability of services. In both cases, local knowledge helped researchers to address both ethnographic as well as practical problems. Researchers identified the ways in which these communities generate and negotiate the cultural meanings of developmental disorders. Researchers incorporated that knowledge, as they engaged communities in a research protocol, adapted and translated screening and diagnostic tools, and developed methods for screening, evaluating, and diagnosing children with ASD.

Perceptions of tuberculosis among immigrants and refugees at an adult education center: a community-based participatory research approach

English as a Second Language programs serve large foreign-born populations in the US with elevated risks of tuberculosis (TB), yet little is known about TB perceptions in these settings. Using a community-based participatory research approach, we elicited perceptions about TB among immigrant and refugee learners and staff at a diverse adult education center. Community partners were trained in focus groups moderation. Ten focus groups were conducted with 83 learners and staff. Multi-level, team-based qualitative analysis was conducted to develop themes that informed a model of TB perceptions among participants. Multiple challenges with TB control and prevention were identified. There were a variety of misperceptions about transmission of TB, and a lack of knowledge about latent TB. Feelings and perceptions related to TB included secrecy, shame, fear, and isolation. Barriers to TB testing include low awareness, lack of knowledge about latent TB, and the practical considerations of transportation, cost, and work schedule conflicts. Barriers to medication use include suspicion of generic medications and perceived side effects. We posit adult education centers with large immigrant and refugee populations as excellent venues for TB prevention, and propose several recommendations for conducting these programs. Content should dispel the most compelling misperceptions about TB transmission while clarifying the difference between active and latent disease. Learners should be educated about TB in the US and that it is curable. Finally, TB programs that include learners and staff in their design and implementation provide greater opportunity for overcoming previously unrecognized barriers.

Community-based participatory research skills and training needs in a sample of academic researchers from a clinical and translational science center in the Northeast

PURPOSE

To determine the community-based participatory research (CBPR) training interests and needs of researchers interested in CBPR to inform efforts to build infrastructure for conducting community-engaged research.

METHOD

A 20-item survey was completed by 127 academic health researchers at Harvard Medical School, Harvard School of Public Health, and Harvard affiliated hospitals.

RESULTS

Slightly more than half of the participants reported current or prior experience with CBPR (58 %). Across all levels of academic involvement, approximately half of the participants with CBPR experience reported lacking skills in research methods and dissemination, with even fewer reporting skills in training of community partners. Regardless of prior CBPR experience, about half of the respondents reported having training needs in funding, partnership development, evaluation, and dissemination of CBPR projects. Among those with CBPR experience, more than one-third of the participants wanted a mentor in CBPR; however only 19 % were willing to act as a mentor.

CONCLUSIONS

Despite having experience with CBPR, many respondents did not have the comprehensive package of CBPR skills, reporting a need for training in a variety of CBPR skill sets. Further, the apparent mismatch between the need for mentors and availability in this sample suggests an important area for development.

Reclaiming the social in community movements: perspectives from the USA and Brazil/South America: 25 years after Ottawa

Since the Ottawa Charter 25 years ago, community participation has been adopted worldwide by nation states and communities as a core health promotion strategy. Rising inequities since that time, however, have been largely unchecked in the Americas and globally, and have presented us with an acutely paradoxical time for community participation and action. On the one hand, transnational globalized markets and accompanying economic and environmental devastation have challenged the effectiveness of community action to create health. On the other hand, hopeful signs of local through national and international activism and of new mechanisms for community engagement continue to surface as meaningful and effective democratic acts. This article presents a dialogue on these issues between colleagues in the United States and Brazil, and considers the broader applicability to Latin America and worldwide. We begin by discussing how community participation and community organizing grew out of our respective histories. We consider the catalytic role of the Ottawa Charter in spurring a reorientation of health promotion and the genesis of healthy city and community initiatives, as well as other current community organizing strategies and the growth of participatory research/CBPR. We unpack the potential for co-optation of both community and social participation and end with recommendations for what we can do to maintain our integrity of belief in democratic social participation to promote improved health and health equity.

Community-based participatory research and smoking cessation interventions: a review of the evidence

This article reviews the evidence of the use of community-based participatory research (CBPR) and smoking cessation interventions. An overview of CBPR is provided, along with a description of the search methods and quality scoring. Research questions are explored to determine if CBPR improves the quality of research methods and community involvement in cessation intervention studies and cessation outcomes when using CBPR approaches. Results of the review are provided along with a comprehensive table summarizing all the included studies. Strengths and challenges of the CBPR approach are presented with recommendations for future research.

Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health

Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC-including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions but also improve the health of the nation-starting with improving the health of their local communities, one community at a time.

A framework for training health professionals in implementation and dissemination science

The authors describe a conceptual framework for implementation and dissemination science (IDS) and propose competencies for IDS training. Their framework is designed to facilitate the application of theories and methods from the distinct domains of clinical disciplines (e.g., medicine, public health), population sciences (e.g., biostatistics, epidemiology), and translational disciplines (e.g., social and behavioral sciences, business administration education). They explore three principles that guided the development of their conceptual framework: Behavior change among organizations and/or individuals (providers, patients) is inherent in the translation process; engagement of stakeholder organizations, health care delivery systems, and individuals is imperative to achieve effective translation and sustained improvements; and IDS research is iterative, benefiting from cycles and collaborative, bidirectional relationships. The authors propose seven domains for IDS training-team science, context identification, literature identification and assessment, community engagement, intervention design and research implementation, evaluation of effect of translational activity, behavioral change communication strategies-and define 12 IDS training competencies within these domains. As a model, they describe specific courses introduced at the University of California, San Francisco, which they designed to develop these competencies. The authors encourage other training programs and institutions to use or adapt the design principles, conceptual framework, and proposed competencies to evaluate their current IDS training needs and to support new program development.

A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups

OBJECTIVE

To examine the effectiveness of current community-based participatory research (CBPR) clinical trials involving racial and ethnic minorities.

DATA SOURCE

All published peer-reviewed CBPR intervention articles in PubMed and CINAHL databases from January 2003 to May 2010.

STUDY DESIGN

We performed a systematic literature review.

DATA COLLECTION/EXTRACTION METHODS

Data were extracted on each study's characteristics, community involvement in research, subject recruitment and retention, and intervention effects.

PRINCIPLE FINDINGS

We found 19 articles meeting inclusion criteria. Of these, 14 were published from 2007 to 2010. Articles described some measures of community participation in research with great variability. Although CBPR trials examined a wide range of behavioral and clinical outcomes, such trials had very high success rates in recruiting and retaining minority participants and achieving significant intervention effects.

CONCLUSIONS

Significant publication gaps remain between CBPR and other interventional research methods. CBPR may be effective in increasing participation of racial and ethnic minority subjects in research and may be a powerful tool in testing the generalizability of effective interventions among these populations. CBPR holds promise as an approach that may contribute greatly to the study of health care delivery to disadvantaged populations.

Preliminary findings exploring the social determinants of Black males' lay health perspectives

The unequal discussion of Black males' health is a pressing social problem. This study addressed Black males' lay perspectives regarding their health, illness, and mortality, with attention to the determinants of men's health, prevention, lifestyle, and opportunities for health promotion using an exploratory/qualitative research methodology. Participants were 68 Black males aged 15 to 68 years, with an average age of 44 years (SD = 14.5). The narratives represented a complex interplay of biopsychosocial factors, ranging from intrapersonal attitudes, interpersonal experiences to discussions about community and public policy injustices. Five prominent themes emerged: (a) lack of chronic disease awareness, (b) fatalism, (c) fear and anxiety of academic-medical settings, (d) hyperactive masculinity fatigue, and (e) the gay-straight divide. The term Tired Black Male Health syndrome was coined in the forum. Implications of these findings are discussed in the context of culturally relevant strategies for improving Black male community health engagement.

Physical activity and nutrition among immigrant and refugee women: a community-based participatory research approach

BACKGROUND

Immigrant and refugee populations arrive to the U.S. healthier than the general population, but the longer they reside, the more they approximate the cardiovascular risk profiles of the country. Among women, these declines are partly mediated by less physical activity and lower dietary quality upon immigration. Given the complex forces that influence these behaviors, a community-based participatory research (CBPR) approach is appropriate. Therefore, a socioculturally responsive physical activity and nutrition program was created with and for immigrant and refugee women in Rochester, Minnesota, through a CBPR approach.

METHODS

Focus groups informed program content and revealed principles for designing the sessions. A 6-week program with two, 90-minute classes per week was conducted among 45 women (Hispanic, Somali, Cambodian, and non-immigrant African American). Average attendance was 22.5 women per class; 34 women completed the evaluation.

RESULTS

Evaluation revealed high acceptability (average overall score of 4.85 out of 5 on the Physical Activity Class Satisfaction Questionnaire). After the intervention, participants were more likely to exercise regularly (p ≤ .001). They reported higher health-related quality of life (p ≤ .001) and self-efficacy for diet (p = .36) and exercise (p = .10). Likewise, there were trends for weight loss (87 vs 83.4 kg; p = .65), decreased waist circumference (99.6 vs 95.5 cm; p = .35), and lower blood pressure (125/80 vs 122/76 mm/Hg; p = .27).

CONCLUSION

A CBPR approach to design and implement a socioculturally responsive fitness program was highly acceptable to immigrant and refugee women and demonstrated promising outcomes. Further testing of physical activity and nutrition interventions that arise organically from target communities are needed.

Capacity building through focus group training in community-based participatory research

BACKGROUND

Community-based participatory research (CBPR) emphasizes collaborative efforts among communities and academics where all members are equitable contributors. Capacity building through training in research methodology is a potentially important outcome for CBPR partnerships.

OBJECTIVES

To describe the logistics and lessons learned from building community research capacity for focus group moderation in the context of a CBPR partnership.

METHODS

After orientation to CBPR principles, members of a US suburban community underwent twelve hours of interactive learning in focus group moderation by a national focus group expert. An additional eight-hour workshop promoted advanced proficiency and built on identified strengths and weaknesses. Ten focus groups were conducted at an adult education center addressing a health concern previously identified by the center's largely immigrant and refugee population. Program evaluation was achieved through multiple observations by community and academic-based observers.

RESULTS

Twenty-seven community and academic members were recruited through established relationships for training in focus group moderation, note-taking, and report compilation. Focus group training led to increased trust among community and research partners while empowering individual community members and increasing research capacity for CBPR.

CONCLUSIONS

Community members were trained in focus group moderation and successfully applied these skills to a CBPR project addressing a health concern in the community. This approach of equipping community members with skills in a qualitative research method promoted capacity building within a socio-culturally diverse community, while strengthening community-academic partnership. In this setting, capacity building efforts may help to ensure the success and sustainability for continued health interventions through CBPR.

The role of community-based participatory research to inform local health policy: a case study

The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the local level. We present the following four mechanisms by which CBPR might increase the ability of health services researchers to impact health by informing local policy. CBPR benefits community partners by allowing them to participate directly in the research process, gives academic researchers access to local data, enhances interpretation of research findings through an understanding of local context, and provides a natural infrastructure for affecting local policy through its community partners. For each of these mechanisms, we describe one example from a CBPR project conducted by one of us (M.O.). Considering the challenges and opportunities of conducting CBPR, future efforts will help describe how this emerging research paradigm can complement traditional health services research to most effectively inform health policy at multiple levels.

A capacity building program to promote CBPR partnerships between academic researchers and community members

INTRODUCTION

Community-based participatory research (CBPR) adds community perspectives to research and aids translational research aims. There is a need for increased capacity in CBPR but few models exist for how to support the development of community/university partnerships.

OBJECTIVE

Evaluate an approach to promote nascent CBPR partnerships.

METHODS

Design was a mixed-methods evaluation using interviews, process notes, and open- and close-ended survey questions. We trained 10 community scholars, matched them with prepared researchers to form seven partnerships, and supported their developing partnerships. Sequential mixed-methods analysis assessed research and partnership processes and identified integrated themes.

RESULTS

Four of seven partnerships were funded within 15 months; all self-reported their partnerships as successful. Themes were: (1) motivators contributed to partnership development and resiliency; (2) partners took on responsibilities that used individuals' strengths; (3) partners grappled with communication, decision making, and power dynamics; and (4) community-university infrastructure was essential to partnership development.

CONCLUSIONS

This program for developing nascent partnerships between academicians and community members may guide others in increasing capacity for CBPR.

Community conceptualizations of health: implications for transdisciplinary team science

OBJECTIVE

This exploratory study set out to identify how communities in the Tufts University Clinical Translational Science Institute (CTSI) catchment area define health-related research priority areas.

METHODS

Three focus groups comprising community stakeholders were conducted in three communities. Participants were representatives from community-based organizations and health centers. A systematic content analysis was performed that involved the identification, labeling, and categorization of data followed by thematic analysis.

RESULTS

Participant conceptualizations of health and health priorities were not formulated in the context of specific disease conditions, such as diabetes, obesity, cardiovascular disease, or asthma. Instead, participants described contextual factors including social, environmental, economic, and political conditions that influence health and health behavior.

CONCLUSIONS

Respondents in the Tufts University CTSI catchment area, like many diverse urban communities, described multiple interconnected social determinants of health and well-being. As such, they were interested in research that focuses on "upstream" areas of intervention as opposed to disease prevention at the individual level. In addition, respondents were interested in research that would catalyze community change.

Public health and medical education: a natural alliance for a new regional medical school

A century ago, the Flexner Report challenged U.S. medical schools to critically evaluate their curricula in order to nurture physicians equipped to meet the needs of an evolving society. Recently, medical educators have been charged to increase the emphasis on prevention, care of populations, public health, and community medicine. The Commonwealth Medical College (TCMC) is a new MD-granting medical school inspired by and founded in response to a community need. The founders' vision was to recruit and train physicians to fill workforce needs in Northeast Pennsylvania. In its first few years, TCMC embarked on two major public health initiatives, the Regional Health Assessment and the Community Health Research Projects (CHRPs). The results of the health assessment have been used to guide TCMC's curricular development and research agenda. The CHRPs foster commitment to community involvement, regional engagement, and participatory research. TCMC partners with various organizations and community physicians to ensure that students learn (1) to apply knowledge and skills acquired through the course of their studies to public health research in varied settings; (2) the fundamentals of community engagement, collaboration, and service-based practice; and (3) to address the different needs of patient subgroups and populations. These programs provide opportunities for students to be active participants in community capacity building while achieving specific competencies in public health. Existing partnerships with community organizations are enhanced, strengthening the regional focus of the school. This model of incorporating public health into medical education can potentially be replicated in other institutions in the U.S. and internationally.

Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives

Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

Community mobilization and community-based participatory research to prevent youth violence among Asian and immigrant populations

Many community mobilization activities for youth violence prevention involve the researchers assisting communities in identifying, adapting, and/or tailoring evidence-based programs to fit the community needs, population, and cultural and social contexts. This article describes a slightly different framework in which the collaborative research/evaluation project emerged from the community mobilization activities. As will be discussed, this collaborative, sustained partnership was possible in the context of the Center on Culture, Immigration and Youth Violence Prevention's (UC Berkeley ACE) community mobilization activities that brought the issue of youth violence, particularly among immigrant and minority populations, to the forefront of many of the community partners' agendas. The East Bay Asian Youth Center (EBAYC) was one of the partners that came to the table, which facilitated the community-based engagement/mobilization. UC Berkeley ACE collaborated with EBAYC to evaluate an after-school program and an alternative probation program serving a diverse youth and immigrant population, including African Americans, Asians, and Hispanics. This article describes UC Berkeley ACE's community mobilization activity and the collaborative partnership with EBAYC, discusses how the evaluations incorporated community-based principles in design and practice, and presents some findings from the evaluations.

Effectively translating diabetes prevention: a successful model in a historically underserved community

Lifestyle interventions can prevent diabetes through weight loss, but they are rarely translated for use in underserved communities. The aim of this study was to describe how a community-academic partnership formed and developed a program to address local health disparities by developing a low-cost, culturally and economically appropriate, peer-led community-based diabetes prevention program. Using a participatory approach, the partnership chose to focus on diabetes prevention, and co-developed all intervention, recruitment, research, and evaluation strategies. The partnership's philosophy to maintain high clinical and scientific standards paired with their ability to represent and engage the community facilitated the development of a randomized controlled trial that achieved statistically significant and sustained weight loss, and the recruitment of a largely Spanish-speaking, low income, uninsured population. The success of this intervention lies in the partnership's commitment to the community, co-ownership of research, and a careful balance between academic rigor and community engagement and relevance.

Rural Latino youth park use: characteristics, park amenities, and physical activity

Less than half of youth engage in sufficient physical activity to achieve health benefits. Key environmental factors of park and recreation spaces may influence youth physical activity. We sought to ascertain youth characteristics and behaviors that attract youth to parks with specific amenities and encourage physical activity while at the parks in a rural, predominantly Latino community. We examined the quality of amenities in the 13 parks and recreation spaces that middle school aged youth have access to in their community using the Environmental Assessment of Parks and Recreation Spaces (EAPRS) tool. Middle school students completed surveys in the school classroom (n = 1,102) regarding park use, physical activity, and intrapersonal characteristics (e.g., motivators). We used logistic regression to identify correlates of any park use, use of higher quality field and court parks, and active and sedentary park use. Younger age, participation in an after school activity, and identification of a team as a motivator were positively associated with any park use. Use of higher quality court and field parks was associated with participation in an after school activity and being Latino. The odds of being active in the parks were greater for boys and Latinos. Older age and alcohol use are correlated with being sedentary at the park, while odds of being sedentary at the park were lower for boys and youth who met physical activity guidelines. Organized team activities may encourage active use of higher quality fields and courts parks by Latino youth; thereby, increasing their level of physical activity.

Beyond the medical model: interdisciplinary programs of community-engaged health research

This report describes four diverse programs of community-engaged research, all of which demonstrated positive health outcomes. Three of the programs were focused on communities of people with diabetes, and one program targeted at-risk young families raising infants and young children. Brief descriptions of each research study and outcomes are presented as well as a discussion of the processes and lessons that were learned from each model of successful interdisciplinary community-university health research partnerships.

Working with culture: lessons learned from a community-engaged project in a Chinese aging population

Despite growing interest in the community-based participatory research method, limited empirical research exists on how to overcome cultural and linguistic barriers in applying community-based participatory research principles within the Chinese elderly community. This article reports on the implementation of a participatory process to assess the health needs of an aging Chinese population. We recorded challenges faced and lessons learned in collecting pilot data on issues pertaining to the health of a community-dwelling older Chinese population (over 60 years of age) in Chicago’s Chinatown (Chicago, IL, USA). We have learned that establishing partnerships with a humble approach, acknowledging community diversity in languages and cultures, building on community strengths, and empowering community through education are important considerations in this collaboration. Implications of these findings for research and practice are discussed.

Screening for tuberculosis at an adult education center: results of a community-based participatory process

OBJECTIVES

We used a community-based participatory research (CBPR) approach to plan and implement free TB skin testing at an adult education center to determine the efficacy of CBPR with voluntary tuberculosis (TB) screening and the prevalence of TB infection among immigrant and refugee populations.

METHODS

We formed a CBPR partnership to address TB screening at an adult education center that serves a large immigrant and refugee population in Rochester, Minnesota. We conducted focus groups involving educators, health providers, and students of the education center, and used this input to implement TB education and TB skin testing among the center's students.

RESULTS

A total of 259 adult learners volunteered to be skin-tested in April 2009; 48 (18.5%) had positive TB skin tests.

CONCLUSIONS

Our results imply that TB skin testing at adult education centers that serve large foreign-born populations may be effective. Our findings also show that a participatory process may enhance the willingness of foreign-born persons to participate in TB skin-testing efforts.

Dialogical action: moving from community-based to community-driven participatory research

Proponents of community-based research advocate for the active involvement and engagement of community members, citing improved construct validity, intervention efficacy, and accountability. However, to create the conditions in which expertise is mutually constructed and in which no one is the object of research, a reconsideration of the fundamental ethos of community involvement and engagement is required. In this article, we seek to accomplish two goals: (a) to briefly assess the definitions of community health, focus groups, and dissemination that are often used in community-based research; and (b) to introduce an application of dialogical action that goes beyond traditional focus group methodology to promote the creation of an evolving and dynamic dialogue among campus and community stakeholders. An urban case study is presented.

Linking service-learning with community-based participatory research: an interprofessional course for health professional students

Service-learning is a valued strategy for educating health professionals. Linking service-learning with community-based participatory research (CBPR) engages students with community stakeholders and faculty in a collaborative process to bring about social change and improved health. The purpose of this paper is to describe a strategy for involving interprofessional students in ongoing faculty CBPR in an underserved community. The process includes the design and implementation of a course that combines weekly seminars with field experiences in the targeted community, emphasizing community assessment, and working with community members to find solutions to health problems. Nursing, public health, and medical students were recruited to the initial course, and offered the opportunity to meet objectives of required components of their disciplinary curriculum. Community members became actively involved in educating students while working to solve identified health problems. Important principles of CBPR--trust, collaboration, excellence in science, and ethics--are emphasized throughout the initiative. This course is now a regular offering for interprofessional students, providing valuable learning experiences for students, faculty, and the community. Ongoing faculty CBPR continues a trusting community-academic relationship and gives the community a voice in the solution for health problems.

Facilitating research faculty participation in CBPR: development of a model based on key informant interviews

Community-based participatory research (CBPR) may enhance the translational research process; however, this would require increased institutional capacity for community engaged research. In this paper, we fi rst present results of key informant interviews with academic health center faculty regarding facilitators to faculty participation in CBPR partnerships and then propose a model arising from these results describing how increased capacity may be achieved. Participants were 13 key informant faculty of varying levels of expertise in CBPR at a large university academic health center. Interviews were recorded and transcribed. A thematic content analysis of each interview was conducted by research team members. Facilitators reported by faculty representing fi ve health science schools were grouped into fi ve thematic areas: (1) researcher personal attributes including an innate orientation toward working with community, (2) positive attitudes toward collaboration, (3) a partnership-building skill set, (4) community partners who are ready and eager to collaborate, and (5) supportive institutional policies and procedures. We propose a model describing the relationship between personal attributes, learned/environmental factors, and community facilitators that may be utilized to promote increased institutional capacity for CBPR and thus increase the likelihood of the successful translation of research findings into community settings.

From controlled trial to community adoption: the multisite translational community trial

Methods for translating the findings of controlled trials, such as the Diabetes Prevention Program, into real-world community application have not been clearly defined. A standardized research methodology for making and evaluating such a transition is needed. We introduce the multisite translational community trial (mTCT) as the research analog to the multisite randomized controlled trial. The mTCT is adapted to incorporate the principles and practices of community-based participatory research and the increased relevance and generalizability gained from diverse community settings. The mTCT is a tool designed to bridge the gap between what a clinical trial demonstrates can work in principle and what is needed to make it workable and effective in real-world settings. Its utility could be put to the test, in particular with practice-based research networks such as the Prevention Research Centers.

Community-based applied research with Latino immigrant families: informing practice and research according to ethical and social justice principles

This manuscript describes the implementation of two community-based programs of research with Latino immigrant populations exposed to intense contextual challenges. We provide background on our program of research and specific implementation of an evidence-based parenting intervention. We also describe how our research efforts were seriously affected by immigration-related events such as the ICE raids in Utah and a history of discrimination and exclusion affecting Latino immigrants in Michigan. These external political and social challenges have affected the very core principles of our efforts to implement community-based approaches. The current manuscript describes key lessons that we have learned in this process. Finally, reflections for research, practice, and social policy are included.

Integration of social epidemiology and community-engaged interventions to improve health equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

Lessons learned during the conduct of clinical studies in the dental PBRN

Effectively addressing challenges of conducting research in nonacademic settings is crucial to its success. A dental practice-based research network called The Dental Practice-Based Research Network (DPBRN) is comprised of practitioner- investigators in two health maintenance organizations, several universities, many U.S. states, and three Scandinavian countries. Our objective in this article is to describe lessons learned from conducting studies in this research context; the studies are conducted by clinicians in community settings who may be doing their first research study. To date, twenty-one studies have been completed or are in implementation. These include a broad range of topic areas, enrollment sizes, and study designs. A total of 1,126 practitioner-investigators have participated in at least one study. After excluding one study because it involved electronic records queries only, these studies included more than 70,000 patient/participant units. Because the DPBRN is committed to being both practitioner- and patient-driven, all studies must be approved by its Executive Committee and a formal study section of academic clinical scientists. As a result of interacting with a diverse range of institutional and regulatory entities, funding agencies, practitioners, clinic staff, patients, academic scientists, and geographic areas, twenty-three key lessons have been learned. Patients' acceptance of these studies has been very high, judging from high participation rates and their completion of data forms. Early studies substantially informed later studies with regard to study design, practicality, forms design, informed consent process, and training and monitoring methods. Although time-intensive and complex, these solutions improved acceptability of practice-based research to patients, practitioners, and university researchers.

Promotion of Physical Activity Among Mexican-Origin Women in Texas and South Carolina: An Examination of Social, Cultural, Economic, and Environmental Factors

Interventions to improve physical activity levels among Latinos must take into consideration the social, cultural, economic, and environmental contexts of Latino communities. We report findings of formative assessments related to Mexican-origin women's levels of readiness, willingness, and ability to participate in regular leisure time physical activity in two diverse locations, the Texas Lower Rio Grande Valley and the South Carolina Midlands. The ENLACE project employed a Community-Based Participatory Research approach. Formative assessment activities focused on identification of community assets and resources and exploration of community members' experiences, opinions, values, preferences, and perceived needs related to physical activity. Data sources included windshield tours, walkability assessments of local neighborhoods; community inventory exercises, focus groups, and individual interviews. Barriers to regular physical activity included the dominance of work and family responsibilities, social norms, lack of social support, social isolation, environmental constraints, economics, and low levels of personal knowledge and motivation.

Community ACTION boards: an innovative model for effective community-academic research partnerships

BACKGROUND

Community-based participatory research (CBPR) requires equitable partnerships between community stakeholders and academics. Traditionally, researchers relied on community advisory boards, but these boards often play a reactive role limited to a project-by-project basis. The East and Central Harlem Health Outcomes (ECHHO) Community Action Board (CAB), however, is an effective, proactive group.

OBJECTIVES

The ECHHO board sought to identify key strategies and tools used to build and sustain the model, and to disseminate lessons learned to other community-academic partnerships.

METHODS

Current and former board members were interviewed and a wide range of related documents was reviewed.

LESSONS LEARNED

The board became effective when it prioritized action and relationship-building, across seven key domains: Shared priorities, diversity, participation, transparency, mutual respect and recognition, and personal connections. The model is depicted graphically.

CONCLUSION

Community advisory boards may benefit from reduced emphasis on protocols and procedures, and increased attention to building relationships between academics and community members.

Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment

Over the last number of years there has been growing interest in the use of community-based participatory research (CBPR) for preventing and controlling complex public health problems. Photovoice is one of several qualitative methods utilized in CBPR, as it is a participatory method that has community participants use photography, and stories about their photographs, to identify and represent issues of importance to them. Over the past several years photovoice methodology has been frequently used to explore community health and social issues. One emerging opportunity for the utilization of photovoice methodology is research on community built and social environments, particularly when looking at the context of the neighbourhood. What is missing from the current body of photovoice literature is a critique of the strengths and weaknesses of photovoice as a method for health promotion research (which traditionally emphasizes capacity-building, community-based approaches) and as a method for revealing residents' perceptions of community as a source of health opportunities or barriers. This paper will begin to address this gap by discussing the successes and challenges of using the photovoice methodology in a recent CBPR project to explore community perceptions of the built and social environment (with the ultimate goal of informing community-based chronic disease prevention initiatives). The paper concludes with methodological recommendations and directions for future research.

CBPR: building partnerships with latinos in a rural area for a wellness approach to mental health

Using Community-Based Participatory Research, this study describes the ongoing collaboration between Latino community leaders and academic partners to develop a mental health promotion intervention for rural Latinos in Florida. Two strategies were used: (1) Community Advisory Board (CAB) members completed a Latino Community Partners Survey (LCPS) and (2) scribe notes were taken during CAB meetings. The LCPS demonstrated not only the CAB's knowledge about the community but the readiness of leaders to get involved in the community-academic partnership. Thematic analysis of scribe notes revealed four main categories: caring, knowledges, interpersonal dynamics, and future impact in the community. CAB members greatly enhanced academic partners' understanding of the community's needs as well as of their own culturally-specific knowledge.

Community engagement in children's environmental health research

Community engagement strategies and skills can build trust and reduce historical mistrust between researchers, communities, and populations being studied, as well as contribute to the quality of study designs, methods, and dissemination of findings. This review paper discusses why community engagement is of increasing importance in children's environmental health research, describes models and the continuum of methods that are used, and discusses their challenges and benefits. Two case studies, representing different study designs and using different community engagement models and methods, and lessons learned from these cases, are described. Community engagement methods are best understood on a continuum based on the degree to which community members or representatives of community populations are involved in research planning, decision-making, and dissemination. Methods along this continuum include community consultation, community-based participatory research, and community consent to research. Community engagement knowledge and skills are especially important in the conduct of children's environmental health research, with its emphasis on reducing environmental risks at the community level, the increasing focus on genetics and gene-environment interactions, and the importance placed on translation of scientific results into behaviors and policies that protect the community. Across study designs, whether qualitative survey research, an observational epidemiology study, or a randomized intervention trial, understanding community interests, norms, and values is necessary to describe attitudes and behaviors of specific population groups, build evidence of cause and effect between environmental exposures and health, and demonstrate the effectiveness of interventions to reduce risks.

Toward a fourth generation of disparities research to achieve health equity

Achieving health equity, driven by the elimination of health disparities, is a goal of Healthy People 2020. In recent decades, the improvement in health status has been remarkable for the U.S. population as a whole. However, racial and ethnic minority populations continue to lag behind whites with a quality of life diminished by illness from preventable chronic diseases and a life span cut short by premature death. We examine a conceptual framework of three generations of health disparities research to understand (a) data trends, (b) factors driving disparities, and (c) solutions for closing the gap. We propose a new, fourth generation of research grounded in public health critical race praxis, utilizing comprehensive interventions to address race, racism, and structural inequalities and advancing evaluation methods to foster our ability to eliminate disparities. This new generation demands that we address the researcher's own biases as part of the research process.

Observations and recommendations for community-based diabetes screenings

PURPOSE

Community-based diabetes screening is common, but its impact on health outcomes is unclear. Screening protocols may not be standardized nor reflect current clinical practice. A community and clinical team examined the quality and consistency of community-based screening to diagnose hyperglycemic states, and it developed a bilingual screening tool to allow screeners to present accurate, actionable results to participants.

METHODS

The team interviewed providers and community members, analyzed forms and educational materials utilized by screeners, and observed local diabetes screening events. Researchers compared glucose parameters used by screeners to published guidelines and observed fingerstick techniques and protocols for education, referral, and follow-up. Screening was divided into 3 phases: participant assessment before testing, obtainment of a sample, and interpretation of and counsel about results.

RESULTS

There was a general lack of consistency in diabetes screening practices at the 12 screenings attended and among the 11 screeners interviewed. Assessment rarely included evaluation of diabetes risk factors or recent caloric intake. Obtaining a sample through fingersticks often included practices known to cause discomfort and decrease accuracy of glucose measurements. Criteria used to categorize results as "normal" or "abnormal" rarely followed published guidelines for laboratory-measured glucose values and varied significantly between screeners. No organization mentioned prediabetes in screenings. Postscreening consultation protocols varied widely.

CONCLUSIONS

Inconsistencies and inaccuracies in screening practices may limit the quality and relevance of community-based diabetes screenings. The impact of local screenings may be enhanced by using a tool that includes concrete steps and precise guidelines.

Community engagement in research: frameworks for education and peer review

Community engagement in research may enhance a community's ability to address its own health needs and health disparities issues while ensuring that researchers understand community priorities. However, there are researchers with limited understanding of and experience with effective methods of engaging communities. Furthermore, limited guidance is available for peer-review panels on evaluating proposals for research that engages communities. The National Institutes of Health Director's Council of Public Representatives developed a community engagement framework that includes values, strategies to operationalize each value, and potential outcomes of their use, as well as a peer-review framework for evaluating research that engages communities. Use of these frameworks for educating researchers to create and sustain authentic community-academic partnerships will increase accountability and equality between the partners.

Partnership research: a practical trial design for evaluation of a natural experiment to improve depression care

BACKGROUND

Translational research is increasingly important as academic health centers transform themselves to meet new requirements of National Institutes of Health funding. Most attention has focused on T1 translation studies (bench to bedside) with considerable uncertainty about how to enhance T2 (effectiveness trials) and especially T3 (implementation studies).

OBJECTIVE

To describe an innovative example of a T3 study, conducted as partnership research with the leaders of a major natural experiment in Minnesota to improve the primary care of depression.

METHODS

All health plans in the state have agreed on a new payment model to support clinics that implement the well-evidenced collaborative care model for depression in the Depression Improvement Across Minnesota: Offering a New Direction initiative. The Depression Improvement Across Minnesota: Offering a New Direction study was developed in an ongoing partnership with the Initiative leaders from 7 health plans, 85 clinics, and a regional quality improvement collaborative to evaluate the implementation and its impacts on patients and other stakeholders. We agreed on a staggered implementation, multiple baseline research design, using the concepts of practical clinical trials and engaged scholarship and have collaborated on all aspects of conducting the study, including joint identification of patient and clinic survey recipients.

RESULTS

Complex study methods have worked well through 20 months because of the commitment of all stakeholders to both the Initiative and the Study. Over 1500 subjects have been recruited from health plan information delivered weekly, and 99.7% of 316 physicians and administrators from all participating clinical organizations have completed the Study surveys.

CONCLUSIONS

Partnership research can greatly facilitate translational research studies.

Balancing scientific and community interests in community-based participatory research

Community-based participatory research is an approach to studying human populations that emphasizes extensive partnerships between researchers and community members. While there are many advantages of this approach, it also faces a number of conceptual and practical challenges, one of which is managing the conflict that sometimes arises between promoting scientific and community interests. This essay explores the potential conflict between scientific and community interests in several different stages of community-based participatory research, including research design, data interpretation, and publication, and makes some suggestions for practice and policy. To manage potential conflicts between scientific and community interests, investigators and community partners should enter into written agreements at the beginning of the study. In some cases, it may be necessary for a third party, such as a review committee from a supporting institution, the community, or a funding agency, to help investigators and community partners resolve disagreements. It may also be useful, in some situations, to publish a dissenting opinion when investigators and community partners cannot agree on how to interpret findings resulting from a study. These strategies may help address some of the challenges of implementing community-based participatory research.

The first decade of the National Drug Abuse Treatment Clinical Trials Network: bridging the gap between research and practice to improve drug abuse treatment

The National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999 to improve the quality of addiction treatment using science as the vehicle. The network brings providers from community-based drug abuse treatment programs and scientists from university-based research centers together in an alliance that fosters bidirectional communication and collaboration. Collaboration enhanced the relevance of research to practice and facilitated the development and implementation of evidence-based treatments in community practice settings. The CTN's 20 completed trials tested pharmacological, behavioral, and integrated treatment interventions for adolescents and adults; more than 11,000 individuals participated in the trials. This article reviews the rationale for the CTN, describes the translation of its guiding principles into research endeavors, and anticipates the future evolution of clinical research within the Network.