A Group Randomized Trial to Reduce Obesity among Appalachian Church Members: The Walk by Faith Study

Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.

A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings

Background

Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs).

Methods

Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings.

Results

Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg.

Conclusions

The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.

Community-Based Participatory Research (CBPR) to Enhance Participation of Racial/Ethnic Minorities in Clinical Trials: A 10-Year Systematic Review

There has not been a significant improvement in the rate of clinical trial accrual in more than 20 years. Worse, the challenge of inadequate representation among racial and ethnic minorities also persists, deepening disparities in health. Community-Based Participatory Research (CBPR) is a participatory communication method that centers on effective dialogue between researchers and community stakeholders with the goal of creating an equitable partnership for health and social change. The objective of the current study was to provide an update since a systematic review in 2012, on the current status of the empirical research, with a particular focus on the elements of CBPR methods used to improve the rate of accrual of members of racial and ethnic minority communities for clinical trials. Our systematic review found a large increase in the number of CBPR related studies and studies related to racial and ethnic representation in research. More than 85% of studies employing CBPR methods saw statistically positive outcomes. Specifically, the elements of CBPR that are associated with these positive outcomes include community partner participation in (1) a study advisory committee, (2) data collection, (3) the development of interventions, and (4) participant recruitment. However, the results of our study indicate that researchers need to be more transparent about the extent of community participation as well as more thoroughly and accurately describe the nature of the partnership with members of minority communities in order to build upon the scientific literature on community-engaged methods.

A Framework for Equitable Partnerships to Promote Cancer Prevention and Control in Rural Settings

Rural populations continue to experience persistent cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination. Although the National Cancer Institute and the larger cancer research community have identified rural community partnerships as the foundation for reducing the disparities, we have identified limited application of community-based participatory research in cancer prevention and control research. Guided by the Community-Based Participatory Research Conceptual Model and our collective experience, we provide a framework for a community-cancer center partnership that focuses on promoting health equity. In this commentary, we articulate that the partnership process must foster capacity for communities and cancer centers, strive for rural representation in clinical trials and biobanking, build a pipeline for dissemination and implementation research, and create a bidirectional flow of knowledge between communities and academic institutions. Authentic partnerships with rural communities should be the ultimate goal of cancer centers, and the process described in this commentary can serve as an initial platform to build capacity and continue to strive toward that goal.

The El Valor de Nuestra Salud clustered randomized controlled trial store-based intervention to promote fruit and vegetable purchasing and consumption

Background

Modifying the environment to promote healthy foods is a population-based approach for improving diet. This study evaluated the outcome effectiveness of a food store intervention that used structural and social change strategies to promote fruits and vegetables. It was hypothesized that intervention versus control store customers would improve their consumption of fruits and vegetables at 6 months.

Trial design

Clustered randomized controlled trial

Methods

Sixteen pair-matched stores were randomized to an intervention or wait-list control condition. With the research team’s support, intervention stores modified the availability, accessibility, and promotion of fruits and vegetables, including augmenting produce displays within the store and building employees’ capacity to place and promote fruits and vegetables throughout the store (Phase 1), followed by the delivery of a customer-directed marketing campaign for 6 months (Phase 2). From months 7 to 12, stores were encouraged to maintain strategies on their own (Phase 3). Customer-reported daily fruit and vegetable consumption (cups/day) were collected by blinded research assistants at three time-points (baseline, 6 months and 12 months post-baseline) from 369 participating customers (an average of 23/store). Secondary outcomes included customer-reported fruit and vegetable purchasing and other behaviors.

Results

The study retained the 16 stores and most customers at 6 (91%) and 12 (89%) months. Although significant differences were not observed in the overall sample for vegetable consumption, male customers of intervention versus control stores consumed significantly more fruit daily at 6 months [mean (standard deviation) cups at baseline and six months; intervention: 1.6 (1.5) to 1.6 (1.5) vs. control: 1.4 (1.2) to 1.1 (0.8)]. However, this difference was not observed at 12 months, or among females. There was an overall increase in dollars spent at the targeted store in the intervention versus control condition among male versus female customers at 6 months; however, no change was observed in the percent of dollars spent on fruits and vegetables at the targeted store. Frequency of shopping at the targeted store did not modify intervention effects.

Conclusions

Structural and social change interventions can modify customers’ behavior in the short-term. Future research should consider methods for achieving longer-term changes, and potential generalizability to other products (e.g., energy-dense sweet and savory products).

Trial registration

NCT01475526

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01220-w.

Physical activity and healthy eating behavior changes among rural women: an exploratory mediation analysis of a randomized multilevel intervention trial

Rural women experience disproportionately higher levels of obesity in comparison to their non-rural counterparts. The present exploratory mediation analysis sought to identify mechanisms that might have contributed to rural women's physical activity and diet changes after participating in a 6-month multilevel community-randomized trial: Strong Hearts, Healthy Communities (SHHC). SHHC was conducted in 16 rural towns in Montana and New York, between 2015 and 2016; 194 overweight, sedentary midlife, and older women (mean age 59; 26.8% overweight; 73.2% obese) participated. Participants in eight towns received the SHHC intervention (n = 101), which focused on healthy behavior change at the individual level as well as creating supportive social and built environments for physical activity and healthy eating. Participants in the other eight towns received an education-only control intervention (n = 93). We investigated the direct and indirect effects of the SHHC intervention through changes to self-efficacy, social support, and built environment perception, on changes in participants' physical activity and diet. Compared to the controls, SHHC intervention participants increased their social support from friends for physical activity (p = 0.009) and healthy eating (p = 0.032). Participants' improved social support from friends marginally mediated the intervention effects for walking metabolic equivalent minutes per week, explaining 40.5% of the total effect (indirect effect = +45.24, 95% CI: -1.51, +91.99; p = 0.059). Increasing social support from friends appears to be helpful in encouraging rural women to become more active. Further investigations are needed to better understand how multilevel interventions work in rural communities.

A systematic review of the use of dietary self-monitoring in behavioural weight loss interventions: delivery, intensity and effectiveness

OBJECTIVE

To identify dietary self-monitoring implementation strategies in behavioural weight loss interventions.

DESIGN

We conducted a systematic review of eight databases and examined fifty-nine weight loss intervention studies targeting adults with overweight/obesity that used dietary self-monitoring.

SETTING

NA.

PARTICIPANTS

NA.

RESULTS

We identified self-monitoring implementation characteristics, effectiveness of interventions in supporting weight loss and examined weight loss outcomes among higher and lower intensity dietary self-monitoring protocols. Included studies utilised diverse self-monitoring formats (paper, website, mobile app, phone) and intensity levels (recording all intake or only certain aspects of diet). We found the majority of studies using high- and low-intensity self-monitoring strategies demonstrated statistically significant weight loss in intervention groups compared with control groups.

CONCLUSIONS

Based on our findings, lower and higher intensity dietary self-monitoring may support weight loss, but variability in adherence measures and limited analysis of weight loss relative to self-monitoring usage limits our understanding of how these methods compare with each other.

Development of a multilevel intervention to increase colorectal cancer screening in Appalachia

BACKGROUND

Colorectal cancer (CRC) screening rates are lower in Appalachian regions of the United States than in non-Appalachian regions. Given the availability of various screening modalities, there is critical need for culturally relevant interventions addressing multiple socioecological levels to reduce the regional CRC burden. In this report, we describe the development and baseline findings from year 1 of "Accelerating Colorectal Cancer Screening through Implementation Science (ACCSIS) in Appalachia," a 5-year, National Cancer Institute Cancer MoonshotSM-funded multilevel intervention (MLI) project to increase screening in Appalachian Kentucky and Ohio primary care clinics.

METHODS

Project development was theory-driven and included the establishment of both an external Scientific Advisory Board and a Community Advisory Board to provide guidance in conducting formative activities in two Appalachian counties: one in Kentucky and one in Ohio. Activities included identifying and describing the study communities and primary care clinics, selecting appropriate evidence-based interventions (EBIs), and conducting a pilot test of MLI strategies addressing patient, provider, clinic, and community needs.

RESULTS

Key informant interviews identified multiple barriers to CRC screening, including fear of screening, test results, and financial concerns (patient level); lack of time and competing priorities (provider level); lack of reminder or tracking systems and staff burden (clinic level); and cultural issues, societal norms, and transportation (community level). With this information, investigators then offered clinics a menu of EBIs and strategies to address barriers at each level. Clinics selected individually tailored MLIs, including improvement of patient education materials, provision of provider education (resulting in increased knowledge, p = .003), enhancement of electronic health record (EHR) systems and development of clinic screening protocols, and implementation of community CRC awareness events, all of which promoted stool-based screening (i.e., FIT or FIT-DNA). Variability among clinics, including differences in EHR systems, was the most salient barrier to EBI implementation, particularly in terms of tracking follow-up of positive screening results, whereas the development of clinic-wide screening protocols was found to promote fidelity to EBI components.

CONCLUSIONS

Lessons learned from year 1 included increased recognition of variability among the clinics and how they function, appreciation for clinic staff and provider workload, and development of strategies to utilize EHR systems. These findings necessitated a modification of study design for subsequent years.

TRIAL REGISTRATION

Trial NCT04427527 is registered at https://clinicaltrials.gov and was registered on June 11, 2020.

Community-Academic Partnerships: Approaches to Engagement

Current public health problems such as cancer have an expansive set of lifestyle and social circumstances that affect the cause and course of the disease. In response, over the past 7 years, the National Cancer Institute (NCI) has recognized the important role that cancer centers play in their community and has gradually increased the requirements and stringency of these sections in the Cancer Center Support Grant guidelines to include a plan for community outreach and engagement. Developing sustainable community-academic partnerships is an essential factor for the successful dissemination and implementation of promising interventions and programs aimed at decreasing barriers and improving cancer outcomes. Understanding how best to facilitate linkages and collaboration can expedite translation of research knowledge into practice and allow more evidence-based improvements to be implemented into practice as well as influence research agendas. This article will examine several examples of successful community-academic partnerships focused on cancer prevention and control and explore lessons learned.