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Herath T, Perera M, Guruge D, Kasturiratne A. Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka. BMJ Open 2024; 14:e075634. [PMID: 39260853 PMCID: PMC11409384 DOI: 10.1136/bmjopen-2023-075634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
OBJECTIVE Healthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess the effectiveness of a participatory intervention to empower communities in improving HLC utilisation. DESIGN A quasi-experimental study based on the principles of community-based participatory research SETTING: Six rural communities each as the intervention (IG) (Gampaha district) and comparison (CG) groups (Kalutara district) from the capital province of Sri Lanka. PARTICIPANTS Study population was healthy individuals aged 35-65 years, the target group of HLCs in Sri Lanka. A random sample of 498 individuals was selected from each group for evaluation. INTERVENTIONS Community support groups (CSGs) were established and empowered using health promotion approach from August 2019 to February 2020. Group discussions and participatory mapping were conducted to identify determinants of underutilisation of HLCs, design activities to address prioritised determinants and develop indicators to monitor the progress of CSGs. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was improvement of HLC utilisation and the secondary outcome was initiation of lifestyle modifications. RESULTS Significant improvements were seen in the IG, compared with the CG in the seven determinants that contribute to HLC utilisation. The largest differences were seen in reducing negative perceptions of susceptibility for NCDs (pre=64.7%; post=33.3%; p<0.001) and usefulness of screening (pre=66.6%; post=17.3%; p<0.001). The HLC utilisation in IG increased by 29.5% (pre=5.85%; 95% CI 3.74 to 7.95, post=35.3%; 95% CI 30.9 to 39.8, p<0.001), while the utilisation of the CG showed no difference. Furthermore, there was an improvement in the proportion of users who initiated lifestyle modification (pre=64.3%; post=89.9%; p=0.039) in IG, which was not observed in CG. CONCLUSION HLC utilisation and initiation of lifestyle modification can be improved by a community-based health promotion intervention through empowering CSGs. TRIAL REGISTRATION NUMBER SLCTR/2019/028.
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Affiliation(s)
- Thilini Herath
- Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University, Sri Lanka, Batticaloa, Sri Lanka
| | - Manuja Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka, Ragama, Sri Lanka
| | - Duminda Guruge
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Sri Lanka, Ragama, Sri Lanka
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McKnight L, Schultz A, Vidic N, Palmer EE, Jaffe A. Learning to make a difference for chILD: Value creation through network collaboration and team science. Pediatr Pulmonol 2024; 59:2257-2266. [PMID: 36855907 DOI: 10.1002/ppul.26377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.
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Affiliation(s)
- Lauren McKnight
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - André Schultz
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Nada Vidic
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
| | - Elizabeth E Palmer
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Centre for Clinical Genetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Respiratory Department, Sydney Children's Hospital, Randwick, New South Wales, Australia
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Morgan R, Kalbarczyk A, Decker M, Elnakib S, Igusa T, Luo A, Toheeb OA, Nakatabira M, Peters DH, Prihartono I, Malhotra A. Gender-responsive monitoring and evaluation for health systems. Health Policy Plan 2024:czae073. [PMID: 39167472 DOI: 10.1093/heapol/czae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 06/21/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024] Open
Abstract
Gender-responsive monitoring and evaluation (M&E) for health and health systems interventions and programs is vital to improve health, health systems, and gender equality outcomes. It can be used to identify and address gender disparities in program participation, outcomes, and benefits, as well as ensure that programs are designed and implemented in a way that is inclusive and accessible for all. While gender-responsive M&E is most effective when interventions and programs intentionally integrate a gender lens, it is relevant for all health systems programs and interventions. Within the literature, gender-responsive M&E is defined in different and diverse ways, making it difficult to operationalize. This is compounded by the complexity and multi-faceted nature of gender. Within this methodological musing, we present our evolving approach to gender-responsive M&E which we are operationalizing within the Monitoring for Gender and Equity (MAGE) project. We define gender-responsive M&E as intentionally integrating the needs, rights, preferences, and power relations among women and girls, men and boys, and gender minority individuals, as well as across social, political, economic, and health systems, in M&E processes. This is done through the integration of different types of gender data and indicators, including: sex or gender specific, sex or gender disaggregated, sex or gender specific/disaggregated which incorporate needs, rights and preferences, and gender power relations and systems indicators. Examples of each of these are included within the paper. Active approaches can also enhance the gender-responsiveness of any M&E activities, including incorporating an intersectional lens and tailoring the types of data and indicators included and processes used to the specific context. Incorporating gender into the programmatic cycle, including M&E, can lead to more fit-for-purpose, effective, and equitable programs and interventions. The framework presented in this paper provides an outline of how to do this, enabling the uptake of gender-responsive M&E.
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Affiliation(s)
- Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shatha Elnakib
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tak Igusa
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Amy Luo
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oladimeji Ayoyemi Toheeb
- Department of Civil and Systems Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, MD, USA
| | - Milly Nakatabira
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Indira Prihartono
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anju Malhotra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Farrell CC, Penuel WR, Arce-Trigatti P, Soland J, Singleton C, Resnick AF, Stamatis K, Riedy R, Henrick E, Sexton S, Wellberg S, Schmidt D. Designing measures of complex collaborations with participatory, evidence-centered design. Front Res Metr Anal 2024; 9:1210547. [PMID: 39188421 PMCID: PMC11345517 DOI: 10.3389/frma.2024.1210547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
An increasingly popular form of collaboration involves forming partnerships among researchers, educators, and community members to improve or transform education systems through research inquiry. However, not all partnerships are successful. The field needs valid, reliable, and useful measures to help with assessing progress toward partnership goals. In this community case study, we present a participatory, mixed-methods approach for creating measures to assess the progress of education research-practice partnerships (RPPs). The case illustrates a novel approach to measurement design, driven by perspectives and feedback of over 300 members of 80 partnerships. As a result, the measures align with the values and practices of the very collaborations the measures were intended to assess.
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Affiliation(s)
- Caitlin C. Farrell
- School of Education, University of Colorado Boulder, Boulder, CO, United States
| | - William R. Penuel
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, United States
| | - Paula Arce-Trigatti
- National Network of Education Research Practice Partnerships, Houston, TX, United States
| | - James Soland
- School of Education and Human Development, University of Virginia, Charlottesville, VA, United States
| | - Corinne Singleton
- School of Education, University of Colorado Boulder, Boulder, CO, United States
| | - Alison Fox Resnick
- School of Education, University of Colorado Boulder, Boulder, CO, United States
| | - Kristina Stamatis
- College of Education, Health, and Human Sciences, University of Nebraska Omaha, Omaha, NE, United States
| | - Robbin Riedy
- School of Education, University of Colorado Boulder, Boulder, CO, United States
| | - Erin Henrick
- Partner to Improve, Nashville, TN, United States
| | | | - Sarah Wellberg
- School of Education and Human Development, University of Virginia, Charlottesville, VA, United States
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Thao MNL, Quoc GN, An MDT, Minh HN, Hong SP, Thai AH, Thi PT, Thanh VNT, Thi NT, Minh TN, Flower B, Cooke GS, Chambers M, Van Nuil JI. Impact of a community-based participatory research project with underserved communities at risk for hepatitis C virus in Ho Chi Minh City, Vietnam: an evaluation study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:82. [PMID: 39113107 PMCID: PMC11304891 DOI: 10.1186/s40900-024-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Participatory approaches have become a widely applied research approach. Despite their popularity, there are many challenges associated with the evaluation of participatory projects. Here we describe an evaluation of a community-based participatory research study of underserved communities in Ho Chi Minh City (HCMC), Vietnam at risk for hepatitis C virus. The goals of our evaluation were to explore the main benefits and challenges of implementing and participating in a participatory study and to describe study impacts. METHODS We conducted two meetings with leaders and members of the participating groups followed by in-depth interviews with 10 participants. We then held a dissemination meeting with over 70 participants, including the representatives of each group, researchers from non-governmental organizations (community-based, national and international), and govenrment officials from the Vietnam Ministry of Health and the Department of Health of HCMC. RESULTS Results include four categories where we describe first the participatory impacts, followed by the collaborative impacts. Then we describe the benefits and challenges of creating and belonging to one of the groups, from members' and leaders' points of view. Finally, we describe the key suggestions that participants provided for future research. CONCLUSION In conclusion, the evaluation approach led to both a research reflection on the 'success' of the project and enabled participants themselves to reflect on the outcomes and benefits of the study from their point of view.
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Affiliation(s)
| | | | - My Do Thi An
- CBPR Community Advisory Groups, Ho Chi Minh City, Vietnam
| | | | - Son Pham Hong
- CBPR Community Advisory Groups, Ho Chi Minh City, Vietnam
| | - Anh Hoang Thai
- CBPR Community Advisory Groups, Ho Chi Minh City, Vietnam
| | - Phung Than Thi
- CBPR Community Advisory Groups, Ho Chi Minh City, Vietnam
| | | | - Ngoc Tran Thi
- CBPR Community Advisory Groups, Ho Chi Minh City, Vietnam
| | | | - Barnaby Flower
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
- Centre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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Park A, van Draanen J. Community-Partnered Research appraisal tool for conducting, reporting and assessing community-based research. BMJ Open 2024; 14:e081625. [PMID: 38670613 PMCID: PMC11057323 DOI: 10.1136/bmjopen-2023-081625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Objective The aim of this study was to develop an appraisal tool to support and promote clear, accurate and transparent standards and consistency when conducting, reporting and assessing community-based research. Design Current recommendations for developing reporting guidelines was used with three key differences: (1) an analysis of existing guides, principles and published literature about community engagement, involvement and participation in research using situational and relational maps; (2) feedback and pilot-testing by a community-based research team; and (3) testing the utility and usability of the appraisal tool. Results After a series of iterative revisions, the resulting Community-Partnered Research (CPR) appraisal tool emerged into three products: an elaborate prospective format, a basic retrospective format, and a supplemental checklist format. All three versions of the CPR appraisal tool consist of 11 main question items with corresponding prompts aimed to facilitate awareness, accountability, and transparency about processes and practices employed by professional researchers and community co-researchers throughout four phases of research: (1) partnership and planning, (2) methods, (3) results and (4) sustainment. Conclusion We hope that introducing this tool will contribute to shifting individual and systematic processes and practices towards equitable partnerships, mutual trustworthiness and empowerment among professional researchers and community co-researchers and, in turn, improving the quality of co-created knowledge that benefits communities and creates social change.
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Affiliation(s)
- Avery Park
- University of Washington - Seattle Campus, Seattle, Washington, USA
| | - Jenna van Draanen
- Child, Family, and Population Health Nursing; Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Mattingly TJ. A Research Framework to Improve Health Disparity Evidence Gaps in Value Assessments. PHARMACOECONOMICS 2024; 42:253-259. [PMID: 38085442 DOI: 10.1007/s40273-023-01340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/13/2024]
Abstract
A value assessment is intended as a tool for evaluating healthcare treatments to gauge value and inform decisions. Economic value assessments typically incorporate a cost-effectiveness analysis, focusing on costs and health outcomes important to payers, missing important information to ensure existing markets optimize resource allocation. Despite frequent calls for more explicit consideration of health equity impacts in value assessments, health economists continue to develop models informed by traditional cost and quality-of-life data that do not capture differences experienced by health disparity populations. This conceptual paper proposes a research framework to enhance data collection and analysis to address these gaps and better quantify the value of a health innovation, and better assess how a new intervention impacts health disparities. The framework comprises three distinct phases that build on one another: (1) contextualization of lived experiences for disadvantaged communities; (2) individual-level quantification of health disparities for cost and quality-of-life measures; and (3) quantifying community-level impacts.
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Affiliation(s)
- T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, 84112, USA.
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Aflatoony L, Hepburn K, Perkins MM. From Empathy to Action: Design Thinking as a Catalyst for Community-Based Participatory Research in Dementia Caregiving. DESIGN FOR HEALTH (ABINGDON, ENGLAND) 2024; 8:24-45. [PMID: 39036349 PMCID: PMC11257414 DOI: 10.1080/24735132.2024.2307225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/11/2024] [Indexed: 07/23/2024]
Abstract
This article delves into the understudied realm of investigating the potential benefits of integrating design thinking into community-based participatory research within the context of culturally diverse dementia caregivers. Following the Double-Diamond process model, we conducted a series of workshops with 15 family caregivers of dementia patients from three distinct communities (multi-racial, Black, and Latino ethnicity) to gain insights into their daily experiences and co-create interventions that could address their pressing challenges. The research question for this study aimed to explore the potential benefits of design thinking in community-based research on dementia caregiving. Our findings contribute to the health design community by demonstrating the potential of design thinking to 1) uncover common and distinct challenges in diverse communities, 2) translate findings into actionable solutions, and 3) design tailored interventions that are responsive to the context-specific needs of the community. Our study leads us to conclude that the integration of design thinking as a catalyst in community-based participatory research has the potential to amplify the identification of nuanced and previously unexamined challenges through empathetic exploration, and to propose innovative interventions that are more amenable to uptake and acceptance within the community.
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Affiliation(s)
- Leila Aflatoony
- Georgia Institute of Technology, Industrial Design, Atlanta, USA
| | - Kenneth Hepburn
- Emory University Woodruff Health Sciences Center, Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Molly M. Perkins
- Emory University School of Medicine, Division of Geriatric Medicine and Gerontology, Atlanta, USA
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Richardson M, Waters SF. Indigenous Voices Against Suicide: A Meta-Synthesis Advancing Prevention Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7064. [PMID: 37998295 PMCID: PMC10671466 DOI: 10.3390/ijerph20227064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023]
Abstract
Rates of suicidality amongst Indigenous Peoples are linked to historical and ongoing settler-colonialism including land seizures, spiritual oppression, cultural disconnection, forced enculturation, and societal alienation. Consistent with decolonial practices, Indigenous voices and perspectives must be centered in the development and evaluation of suicide prevention programs for Indigenous Peoples in the United States to ensure efficacy. The current study is a meta-synthesis of qualitative research on suicide prevention among Indigenous populations in the United States. Findings reveal little evidence for the centering of participant voices within existing suicide prevention programs. Applied thematic analysis of synthesis memos developed for each article in the final sample surfaced four primary themes: (1) support preferences; (2) challenges to suicide prevention; (3) integration of culture as prevention; and (4) grounding relationships in prevention. The need for culturally centered programming and the inadequacy of 'pan-Indian' approaches are highlighted. Sub-themes with respect to resiliency, kinship connection, and safe spaces to share cultural knowledge also emerge. Implications of this work to further the decolonization of suicide prevention and aid in the promotion of culturally grounded prevention science strategies are discussed.
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Affiliation(s)
- Meenakshi Richardson
- Prevention Science Program, Washington State University Vancouver, Vancouver, WA 98686, USA
| | - Sara F. Waters
- Department of Human Development, Washington State University Vancouver, Vancouver, WA 98686, USA;
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Sanchez-Youngman S, Adsul P, Gonzales A, Dickson E, Myers K, Alaniz C, Wallerstein N. Transforming the field: the role of academic health centers in promoting and sustaining equity based community engaged research. Front Public Health 2023; 11:1111779. [PMID: 37457247 PMCID: PMC10345346 DOI: 10.3389/fpubh.2023.1111779] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. This article describes the feasibility and preliminary findings from engaging champion teams from three very different academic health centers. We reflect on the learnings from Engage for Equity PLUS; the adaptation of the intervention design and implementation, including the development of a new institutional assessment using mixed research methods; and our organizational theory of change. In summary, our design and preliminary data from the three academic health centers provide support for new attention to the role of institutional practices and processes needed to sustain equity-based patient and community-engaged research and CBPR and transform the field.
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Affiliation(s)
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Amber Gonzales
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Elizabeth Dickson
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
| | - Katie Myers
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Christina Alaniz
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Nina Wallerstein
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
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Gerritse K, Martens C, Bremmer MA, Kreukels BPC, de Vries ALC, Molewijk BC. GenderJourney: Participatory development of an ethics support tool to foster dialogue and reflection on shared decision-making in gender-affirming medical care. PATIENT EDUCATION AND COUNSELING 2023; 114:107854. [PMID: 37356115 DOI: 10.1016/j.pec.2023.107854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To describe and reflect on the development process of GenderJourney: an ethics support tool that seeks to foster (dialogue and reflection on) shared decision-making (SDM) in gender-affirming medical care (GAMC). METHODS Part of a larger project, this study used a participatory design. We included transgender and gender diverse (TGD) clients and healthcare professionals (HCPs) throughout the study in co-creation workshops. In an iterative process, we (1) established stakeholders' needs, (2) reached a consensus on the aims, content, and design, (3) developed and tested successive renditions, and (4) presented the final version of the tool. RESULTS The final tool aims to (A) elucidate the client's care request and corresponding treatment preferences, (B) foster an explicit dialogue between TGD client and HCP about expected/preferred decisional roles and collaboration, (C) stimulate a systematic joint reflection on and handling of SDM-related ethical challenges. CONCLUSION The GenderJourney provides non-directive ethics support to jointly reflect on and foster good SDM, including its inherent ethical challenges. Future studies should focus on its implementation and actual contribution to good SDM. PRACTICE IMPLICATIONS GenderJourney may be used in GAMC to support the dialogue on what good SDM entails and the identification, discussion, and handling of SDM-related ethical challenges.
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Affiliation(s)
- Karl Gerritse
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Casper Martens
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Marijke A Bremmer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
| | - Baudewijntje P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Medical Psychology, Amsterdam UMC location VUmc, location Vrije Universiteit Amsterdam, the Netherlands.
| | - Annelou L C de Vries
- Center of Expertise on Gender Dysphoria, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands; Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, the Netherlands.
| | - Bert C Molewijk
- Ethics, Law, and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, the Netherlands.
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Disney L, Ahmed R, Carnes S. Advancing Community-Based Participatory Research During the COVID-19 Pandemic: A Methods Commentary on the Lessons Learned from Working with Community Data Collectors on a Refugee Health Disparities Study. JOURNAL OF HEALTH COMMUNICATION 2023; 28:2-6. [PMID: 37390015 DOI: 10.1080/10810730.2023.2187102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
This methods commentary focuses on lessons learned from working with community data collectors on a refugee health disparities study during the COVID-19 pandemic. While there is a strong literature base for community health workers in refugee or migrant communities, there is less known about the procedural elements, challenges, and effectiveness of using community data collectors (CDCs) in research with refugee or migrant communities. Recognizing the cultural wealth and unique strengths of local stakeholders in the refugee community, the research team employed a robust collaborative approach by partnering with CDCs to design and administer the Telehealth and COVID-19 Knowledge, Attitudes, and Practices in New York Refugee Communities Survey. The study's success was largely due to the CDC partnership. This methods commentary highlights the utility of Community-Based Participatory Research as a culturally-responsive framework well-suited to exploring health disparities as part of a broader agenda of public health communication research.
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Affiliation(s)
- Lindsey Disney
- School of Social Welfare, University at Albany, Albany, New York, USA
| | - Rukhsana Ahmed
- Department of Communications, University at Albany, Albany, New York, USA
| | - Stephanie Carnes
- School of Social Welfare, University at Albany, Albany, New York, USA
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Chandanabhumma PP, Gabrysiak A, Brush BL, Coombe CM, Eng E, Jensen M, Lachance L, Shepard P, Wallerstein NB, Israel BA. Cultivating an Ecosystem: A Qualitative Exploration of Sustainability in Long-Standing Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 2023; 17:e5. [PMID: 38682363 PMCID: PMC10651163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: While sustainability is crucial to the success of community-based participatory research (CBPR) partnerships, there is a lack of conceptual clarity on what defines sustainability and what characterizes sustainability-promoting practices in long-standing (in existence ≥ 6 years) CBPR partnerships. Objectives: The aim of this article is to explore the definition of sustainability, as well as practices that influence sustainability from the perspectives of academic and community experts in long-standing CBPR partnerships. Methods: This qualitative analysis is part of Measurement Approaches to Partnership Success (MAPS), a participatory mixed methods validity study that examined “success” and its contributing factors in long-standing CBPR partnerships. Thematic analysis of 21 semi-structured interviews was conducted, including 10 academic and 11 community experts of long-standing CBPR partnerships. Results: The key defining components of sustainability we identified include: distinguishing between sustaining the work of the partnership and ongoing relationships among partners; working towards a common goal over time; and enduring changes that impact the partnership. We further identified strengthening and capacity building practices at multiple levels of the partnership that served to promote the sustainability of the partnership’s work and of ongoing relationships among partners. Conclusions: Sustainability can be understood as supporting an ecosystem that surrounds the beneficial relationships between academic and community partners. Ongoing evaluation and application of practices that promote the sustainability of partnership activities and relationships may strengthen the long-term effectiveness of CBPR partnerships in advancing health equity.
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Affiliation(s)
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Eugenia Eng
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nina B. Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, NM
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14
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Boyd RC, Castro FG, Finigan-Carr N, Okamoto SK, Barlow A, Kim BKE, Lambert S, Lloyd J, Zhang X, Barksdale CL, Crowley DM, Maldonado-Molina M, Obasi EM, Kenney A. Strategic Directions in Preventive Intervention Research to Advance Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 24:577-596. [PMID: 36469162 PMCID: PMC9734404 DOI: 10.1007/s11121-022-01462-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/09/2022]
Abstract
As commissioned by the Society for Prevention Research, this paper describes and illustrates strategic approaches for reducing health inequities and advancing health equity when adopting an equity-focused approach for applying prevention science evidence-based theory, methodologies, and practices. We introduce an ecosystemic framework as a guide for analyzing, designing, and planning innovative equity-focused evidence-based preventive interventions designed to attain intended health equity outcomes. To advance this process, we introduce a health equity statement for conducting integrative analyses of ecosystemic framework pathways, by describing the role of social determinants, mechanisms, and interventions as factors directly linked to specific health equity outcomes. As background, we present health equity constructs, theories, and research evidence which can inform the design and development of equity-focused intervention approaches. We also describe multi-level interventions that when coordinated can produce synergistic intervention effects across macro, meso, and micro ecological levels. Under this approach, we encourage prevention and implementation scientists to apply and extend these strategic directions in future research to increase our evidence-based knowledge and theory building. A general goal is to apply prevention science knowledge to design, widely disseminate, and implement culturally grounded interventions that incrementally attain specific HE outcomes and an intended HE goal. We conclude with recommendations for conducting equity-focused prevention science research, interventions, and training.
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Affiliation(s)
- Rhonda C Boyd
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - Allison Barlow
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
| | | | | | - Jacqueline Lloyd
- Office of Disease Prevention, National Institutes of Health, Rockville, MD, USA
| | - Xinzhi Zhang
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Crystal L Barksdale
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Anne Kenney
- John Hopkins Center for American Indian Health, Baltimore, MD, USA
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15
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Cai HTN, Tran HT, Nguyen YHT, Vu GQT, Tran TP, Bui PB, Nguyen HTT, Pham TQ, Lai AT, Van Nuil JI, Lewycka S. Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam. Front Public Health 2022; 10:822873. [PMID: 35958847 PMCID: PMC9362799 DOI: 10.3389/fpubh.2022.822873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 06/22/2022] [Indexed: 12/02/2022] Open
Abstract
Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects.
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Affiliation(s)
| | - Hang Thi Tran
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | | | | | | | - Huong Thi Thu Nguyen
- Communicable Disease Control and Prevention, National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | - Thai Quang Pham
- Communicable Disease Control and Prevention, National Institute for Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sonia Lewycka
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- *Correspondence: Sonia Lewycka
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16
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Coulter K, Ingram M, Lohr A, Figueroa C, Coronado G, Espinoza C, Esparza M, Monge S, Velasco M, Itule-Klasen L, Bowen M, Wilkinson-Lee A, Carvajal S. Adaptation of a Community Clinical Linkages Intervention to the COVID-19 Pandemic: A Community Case Study. Front Public Health 2022; 10:877593. [PMID: 35812475 PMCID: PMC9256923 DOI: 10.3389/fpubh.2022.877593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
In this community case study, we describe the process within an academic-community partnership of adapting UNIDOS, a community health worker (CHW)-led community-clinical linkages (CCL) intervention targeting Latinx adults in Arizona, to the evolving landscape of the COVID-19 pandemic. Consistent with community-based participatory research principles, academic and community-based partners made decisions regarding changes to the intervention study protocol, specifically the intervention objectives, participant recruitment methods, CHW trainings, data collection measures and management, and mode of intervention delivery. Insights from this case study demonstrate the importance of community-based participatory research in successfully modifying the intervention to the conditions of the pandemic and also the cultural background of Latinx participants. This case study also illustrates how a CHW-led CCL intervention can address social determinants of health, in which the pandemic further exposed longstanding inequities along racial and ethnic lines in the United States.
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Affiliation(s)
- Kiera Coulter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- *Correspondence: Kiera Coulter
| | - Maia Ingram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Abby Lohr
- Department of Community Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Carlos Figueroa
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Gloria Coronado
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Cynthia Espinoza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Maria Esparza
- Yuma County Public Health Services District, Yuma, AZ, United States
| | - Stacey Monge
- Pima County Health Department, Tucson, AZ, United States
| | - Maria Velasco
- El Rio Community Health Center, Tucson, AZ, United States
| | | | | | - Ada Wilkinson-Lee
- Department of Mexican American Studies, University of Arizona, Tucson, AZ, United States
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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17
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Adsul P, Chambers D, Brandt HM, Fernandez ME, Ramanadhan S, Torres E, Leeman J, Baquero B, Fleischer L, Escoffery C, Emmons K, Soler M, Oh A, Korn AR, Wheeler S, Shelton RC. Grounding implementation science in health equity for cancer prevention and control. Implement Sci Commun 2022; 3:56. [PMID: 35659151 PMCID: PMC9164317 DOI: 10.1186/s43058-022-00311-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The past decade of research has seen theoretical and methodological advances in both implementation science and health equity research, opening a window of opportunity for facilitating and accelerating cross-disciplinary exchanges across these fields that have largely operated in siloes. In 2019 and 2020, the National Cancer Institute's Consortium for Cancer Implementation Science convened an action group focused on 'health equity and context' to identify opportunities to advance implementation science. In this paper, we present a narrative review and synthesis of the relevant literature at the intersection of health equity and implementation science, highlight identified opportunities (i.e., public goods) by the action group for advancing implementation science in cancer prevention and control, and integrate the two by providing key recommendations for future directions. DISCUSSION In the review and synthesis of the literature, we highlight recent advances in implementation science, relevant to promoting health equity (e.g., theories/models/frameworks, adaptations, implementation strategies, study designs, implementation determinants, and outcomes). We acknowledge the contributions from the broader field of health equity research and discuss opportunities for integration and synergy with implementation science, which include (1) articulating an explicit focus on health equity for conducting and reviewing implementation science; (2) promoting an explicit focus on health equity in the theories, models, and frameworks guiding implementation science; and (3) identifying methods for understanding and documenting influences on the context of implementation that incorporate a focus on equity. To advance the science of implementation with a focus on health equity, we reflect on the essential groundwork needed to promote bi-directional learning between the fields of implementation science and health equity research and recommend (1) building capacity among researchers and research institutions for health equity-focused and community-engaged implementation science; (2) incorporating health equity considerations across all key implementation focus areas (e.g., adaptations, implementation strategies, study design, determinants, and outcomes); and (3) continuing a focus on transdisciplinary opportunities in health equity research and implementation science. We believe that these recommendations can help advance implementation science by incorporating an explicit focus on health equity in the context of cancer prevention and control and beyond.
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Affiliation(s)
- Prajakta Adsul
- Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - David Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD USA
| | - Heather M. Brandt
- HPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | - Essie Torres
- East Carolina University, 2309 Carol Belk Bldg, Greenville, NC 27858 USA
| | | | - Barbara Baquero
- University of Washington, 3980 15th Ave. NE, Seattle, WA 98195 USA
| | | | - Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 USA
| | - Karen Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Montserrat Soler
- Ob/Gyn and Women’s Health Institute, Cleveland Clinic, Cleveland, OH USA
| | - April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science, Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - Stephanie Wheeler
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7411, Chapel Hill, NC 27599 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, 722 W 168th Street, New York, NY 10032 USA
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18
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Oetzel JG, Boursaw B, Magarati M, Dickson E, Sanchez-Youngman S, Morales L, Kastelic S, Eder MM, Wallerstein N. Exploring theoretical mechanisms of community-engaged research: a multilevel cross-sectional national study of structural and relational practices in community-academic partnerships. Int J Equity Health 2022; 21:59. [PMID: 35501798 PMCID: PMC9063068 DOI: 10.1186/s12939-022-01663-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Community-Based Participatory Research (CBPR) is often used to address health inequities due to structural racism. However, much of the existing literature emphasizes relationships and synergy rather than structural components of CBPR. This study introduces and tests new theoretical mechanisms of the CBPR Conceptual Model to address this limitation. Methods Three-stage online cross-sectional survey administered from 2016 to 2018 with 165 community-engaged research projects identified through federal databases or training grants. Participants (N = 453) were principal investigators and project team members (both academic and community partners) who provided project-level details and perceived contexts, processes, and outcomes. Data were analyzed through structural equation modeling and fuzzy-set qualitative comparison analysis. Results Commitment to Collective Empowerment was a key mediating variable between context and intervention activities. Synergy and Community Engagement in Research Actions were mediating variables between context/partnership process and outcomes. Collective Empowerment was most strongly aligned with Synergy, while higher levels of Structural Governance and lower levels of Relationships were most consistent with higher Community Engagement in Research Actions. Conclusions The CBPR Conceptual Model identifies key theoretical mechanisms for explaining health equity and health outcomes in community-academic partnerships. The scholarly literature’s preoccupation with synergy and relationships overlooks two promising practices—Structural Governance and Collective Empowerment—that interact from contexts through mechanisms to influence outcomes. These results also expand expectations beyond a “one size fits all” for reliably producing positive outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01663-y.
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Affiliation(s)
- John G Oetzel
- University of Waikato, Waikato Management School, Hamilton, New Zealand.
| | - Blake Boursaw
- University of New Mexico, College of Nursing, Albuquerque, USA
| | - Maya Magarati
- Department of Psychiatric and Behavioral Sciences, University of Washington, Seven Directions: A Center for Indigneous Public Health, Center for the Study of Health and Risk Behaviors, School of Medicine, Seattle, USA
| | | | | | - Leo Morales
- University of Washington, School of Medicine, Seattle, USA
| | - Sarah Kastelic
- National Indian Child Welfare Association, Portland, USA
| | - Milton Mickey Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - Nina Wallerstein
- University of New Mexico, Center for Participatory Research, Albuquerque, USA
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19
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Santos ROMD, Abreu MMD, Migowski A, Engstrom EM. Decision aid for prostate cancer screening in Brazil. Rev Saude Publica 2022; 56:19. [PMID: 35416845 PMCID: PMC8973024 DOI: 10.11606/s1518-8787.2022056003467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To present the development and validation processes of a decision aid for prostate cancer screening in Brazil. METHODS Study with qualitative-participatory design for the elaboration of a decision aid for prostate cancer screening, with the participation of a group of men and physicians inserted in primary health care in 11 Brazilian states. Evidence synthesis, field testing, and use in clinical scenarios were performed to adapt the content, format, language, and applicability towards the needs of the target audience in the years 2018 and 2019. The versions were subsequently evaluated by the participants and modified based on the data obtained. RESULTS We elaborated an unprecedented tool in Brazil, with information about the tests used in the screening, comparison of their possible benefits and harms and a numerical infographic with the consequences of this practice. We verified the decision aid usability to assist in the communication between the doctor and the man in the context of primary health care, besides identifying the need for greater discussion about sharing decisions in clinical scenarios. CONCLUSION The tool was easy to use, objective, and has little interference in consultation time. It is a technical-scientific material, produced by research, with the participation of its main target audience and which is available free of charge for use in Brazilian clinical scenarios.
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Affiliation(s)
| | - Mirhelen Mendes de Abreu
- Universidade Federal do Rio de Janeiro. Programa de Pós-Graduação em Clínica Médica da Faculdade de Medicina. Rio de Janeiro, RJ, Brasil
| | - Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva. Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil
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20
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Ballard R, Arteaga SS, Berrigan D, Devlin HM, Galuska DA, Hamner HC, Kettel Khan L, Moore LV, Pannucci TE, Reedy J, Sharfman AS. Advancing Measurement to Address Childhood Obesity: Results of 3 Workshops. Am J Prev Med 2021; 61:e296-e304. [PMID: 34801209 DOI: 10.1016/j.amepre.2021.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Rachel Ballard
- National Collaborative on Childhood Obesity Research, Washington, District of Columbia
| | - S Sonia Arteaga
- Environmental influences on Child Health Outcomes (ECHO) Program Office, Office of the Director, NIH, Bethesda, Maryland
| | | | - Heather M Devlin
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Deborah A Galuska
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Heather C Hamner
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Laura Kettel Khan
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Latetia V Moore
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - TusaRebecca E Pannucci
- Center for Nutrition Policy and Promotion, U.S. Department of Agriculture, Alexandria, Virginia
| | - Jill Reedy
- National Cancer Institute, NIH, Bethesda, Maryland
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21
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Speak AF, Montagnani L, Solly H, Wellstein C, Zerbe S. The impact of different tree planting strategies on ecosystem services and disservices in the piazzas of a northern Italian city. Urban Ecosyst 2021. [DOI: 10.1007/s11252-021-01158-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AbstractAchieving urban sustainability goals, and improving the quality of life in cities, are aided by the careful selection of tree species for public green spaces. Numerous trade-offs and synergies are necessary to consider when selecting tree species for successful public green spaces and there is little data on effective species mixes. In this transdisciplinary research we consider the relative impacts of nine different tree planting scenarios, as modelled with i-Tree, in three piazzas of Bolzano, North Italy. The scenarios consider the opinions of the general public gathered from focused workshops and data collected via a purposefully created smartphone application in addition to data from local urban tree inventories. Shade provision and aesthetics were the primary factors that influenced citizen tree preferences. Scenarios which included larger tree species generally performed the best due to the greater provision of ecosystem services that arises with larger tree dimensions. Ecosystem disservices also increase with larger trees but can be minimised by careful species selection. Public participation in the planning of urban green spaces can be a beneficial activity which ensures new planning outputs will be well-received whilst providing opportunities for education of citizens about the multiple ecosystem services and disservices in urban contexts. Model outputs revealed that different tree species choices can have greatly different impacts in terms of ecosystem service and disservice provision.
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22
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Castro-Ramirez F, Al-Suwaidi M, Garcia P, Rankin O, Ricard JR, Nock MK. Racism and Poverty are Barriers to the Treatment of Youth Mental Health Concerns. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:534-546. [PMID: 34339320 DOI: 10.1080/15374416.2021.1941058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traditional studies of treatment moderators have focused largely on psychological factors such as clinical severity. Racial and economic inequity exert large effects on youth mental health, on treatment efficacy, and on the likelihood of receiving treatment altogether. Yet, these factors are studied less often by clinical psychological scientists. METHOD We conducted a narrative review of literature on racial and economic inequities and their impact on youth mental health. RESULTS First, systemic problems such as racism and poverty increase the risk of developing complex health issues and decrease the likelihood of benefiting from treatment. Second, attitudinal barriers, such as mistrust associated with treatments provided by researchers and government agencies, decrease the likelihood that minoritized groups will engage with or benefit from evidence-based treatments. Third, minoritized and underserved communities are especially unlikely to receive evidence-based treatment. CONCLUSION Clinical psychological science has unique insights that can help address systemic inequities that can decrease treatment efficacy for youth mental health treatment. Psychological scientists can help eliminate disparities in accessing evidence-based treatment and help end violent policies in underserved minoritized communities by at the very least (1) building and supporting scalable community-based treatments as well as (2) publicly advocating for an end to violent policies that impose negative social costs.
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Affiliation(s)
| | | | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University.,Department of Psychiatry, Massachusetts General Hospital.,Mental Health Research Program, Franciscan Children's
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23
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Sanchez-Youngman S, Boursaw B, Oetzel J, Kastellic S, Devia C, Scarpetta M, Belone L, Wallerstein N. Structural Community Governance: Importance for Community-Academic Research Partnerships. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:271-283. [PMID: 33890308 DOI: 10.1002/ajcp.12505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Community based participatory research (CBPR) emphasizes democratic knowledge production and joint action between academics and communities to promote health equity through multilevel interventions. While much scholarship has expressed a commitment to collaboration between researchers and communities, effective methods of structural governance between community and academic stakeholders is under explored. We fill this gap by presenting a conceptual and empirical analysis describing multiple dimensions of structural governance in CBPR partnerships. First, we integrate public policy evidence on effective collaborative governance designs with the emerging literature in CBPR to create a conceptual model. Next, we utilize internet surveys of 179 federally funded community engaged research projects to construct and assess a measure of structural governance across multiple dimensions using confirmatory factor analysis. We explore whether antecedent factors such as the stage of the partnership and ethnic composition are associated with these dimensions and we examine associations for each of these components on positive perceptions of community involvement of research and collective empowerment. We develop a robust multidimensional measure of structural governance that is positively associated with perceptions of increased community involvement in research and collective empowerment.
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Affiliation(s)
| | | | - John Oetzel
- University of Waikato, Hamilton, New Zealand
| | - Sara Kastellic
- National Indian Child Welfare Association, Portland, OR, USA
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24
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Wallerstein N. Engage for Equity: Advancing the Fields of Community-Based Participatory Research and Community-engaged Research in Community Psychology and the Social Sciences. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:251-255. [PMID: 34237169 DOI: 10.1002/ajcp.12530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Community Based Participatory Research (CBPR), as the most cited Community-Engaged Research (CEnR) approach in the health fields, mirrors community-psychology's long-term interest in participatory action research and community empowerment. This article introduces the Engage for Equity study, a long-term National Institutes of Health-funded inquiry to identify best partnering and collaborative practices that contribute to community capacity, empowerment and policy outcomes, and to long-term improved health and health equity. Four articles present facets of the study: psychometrics of partnering process and outcome measures, measures and outcomes of shared governance, and description of the CBPR Model as a new equity- and partnership based implementation framework; and as a tool for organizational learning and quality improvement. Finally a review of CBPR and CEnR in psychology offers recommendations for the field. Though focusing on CBPR and CEnR, Engage for Equity offers lessons for all forms of participatory action research.
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Affiliation(s)
- Nina Wallerstein
- College of Population Health, University of New Mexico, Albuquerque, NM, USA
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25
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Chanchien Parajón L, Hinshaw J, Sanchez V, Minkler M, Wallerstein N. Practicing Hope: Enhancing Empowerment in Primary Health Care through Community-based Participatory Research. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:297-311. [PMID: 34114236 DOI: 10.1002/ajcp.12526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The World Health Organization's (WHO's) Declaration of Alma Ata in 1978 made Primary Health Care (PHC) the official health policy of all WHO member countries, stressing the importance of multisectoral collaboration and community empowerment as critical for delivering quality primary healthcare and public health services to achieve social justice and health equity. Over forty years later, a divide remains between seeing individual patients in the traditional biomedical model and addressing population-level social determinants of health. One promising approach for the intentional and active integration of multi-sectoral partnering practices and community empowerment into Primary Health Care is the use of community-based participatory research (CBPR). The power of CBPR lies in its systematic approach to facilitating equitable collaboration of partners based on community priorities and strengths and is increasingly recognized for improving health equity outcomes. This paper highlights the use of CBPR as a promising practice for healthcare organizations to bridge the gap between the traditional individual patient focus and the comprehensive primary healthcare approach from WHO. We use a narrative case study from A Ministry of Sharing (AMOS) Health and Hope, a PHC organization in Nicaragua, to illustrate the use of the CBPR model as an implementation framework that facilitated the transformation of structures, policies, and practices as AMOS created multi-sector partnerships and embraced community empowerment as part of its strategic and comprehensive approach to health equity.
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Affiliation(s)
| | | | | | - Meredith Minkler
- University of California Berkeley School of Public Health, Berkeley, CA, USA
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Boursaw B, Oetzel JG, Dickson E, Thein TS, Sanchez-Youngman S, Peña J, Parker M, Magarati M, Littledeer L, Duran B, Wallerstein N. Scales of Practices and Outcomes for Community-Engaged Research. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:256-270. [PMID: 33599288 PMCID: PMC8355013 DOI: 10.1002/ajcp.12503] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Despite the growth of research on community-engaged research (CEnR), recent reviews suggest there has been limited development of validated scales to measure key contexts, mechanisms, and outcomes, impairing testing and refinement of theoretical models. The purpose of this study is to present the psychometric properties of scales from the Engage for Equity (E2) project, stemming from a long-term research partnership examining community-engaged research projects. This study used a three-stage, cross-sectional format: (a) a sampling frame of 413 CEnR projects was identified; (b) 210 principal investigators completed a project-level survey and nominated partners for another survey; (c) 457 investigators and partners completed a survey about project contexts, processes, interventions, and outcomes. Factorial validity was established through confirmatory factor analysis supporting seven scales: contextual capacity, commitment to collective empowerment, relationships, community engagement in research actions, synergy, partner and partnership transformation, and projected outcomes. Convergent validity was established through examining covariances among the scales. This study largely yielded results consistent with a previous psychometric study of related measures, while demonstrating improved ceiling effects of the items and refined conceptualization of core theoretical constructs.
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DeCamp LR, Acosta J, Bou Delgado L, Guerrero Vazquez M, Polk S. Community partnerships in emerging immigrant communities: Lessons learned addressing Latino childhood weight disparities. Public Health Nurs 2021; 38:288-295. [PMID: 33586139 DOI: 10.1111/phn.12875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/03/2020] [Accepted: 01/11/2021] [Indexed: 11/29/2022]
Abstract
Latino children have disproportionately high childhood obesity rates, and U.S.-born Latino children of immigrant parents experience higher overweight/obesity rates than other Latino children. Community-based participatory research (CBPR) to engage Latino immigrant families and Latino-serving community organizations is one mechanism to address the lack of effective and practical interventions addressing childhood obesity disparities among Latino children. We present lessons learned from applying CBPR methods to a partnership focused on developing a child obesity treatment program for Latino immigrant families in an emerging Latino immigrant destination to inform the use of CBPR methods in other partnerships in emerging immigrant communities. We encountered challenges working within the partnership related to entrenched sociopolitical hierarchies that were not inclusive of immigrant community leaders, capacity building for partners with limited literacy and administrative experience, and how best to use complementary methods and frameworks to support a community-engaged research process. This work is one way to promote shared learning among the community of researchers using CBPR and other engagement methods to partner with emerging immigrant communities. Together with our community partners, we can identify strategies to more effectively partner to promote health equity and work toward social justice for all members of our communities.
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Affiliation(s)
- Lisa Ross DeCamp
- ACCORDS (Adult and Child Consortium for Health Outcomes Research and Delivery Science), Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.,Latino Research and Policy Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jennifer Acosta
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura Bou Delgado
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica Guerrero Vazquez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Shelton RC, Adsul P, Oh A, Moise N, Griffith DM. Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211049482. [PMID: 37089985 PMCID: PMC9978668 DOI: 10.1177/26334895211049482] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, USA
| | - Prajakta Adsul
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - April Oh
- Division of Cancer Control and Population Sciences, Implementation
Science Team, National Cancer Institute, Rockville, USA
| | - Nathalie Moise
- Department of Medicine, Columbia University Irving Medical
Center, New York, USA
| | - Derek M. Griffith
- Georgetown University, Racial Justice Institute, Washington,
USA
- Georgetown University, Center for Men’s Health Equity, Washington,
USA
- Department of Health Systems Administration at the School of Nursing
& Health Studies, Georgetown University, Washington, USA
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Rodríguez Espinosa P, Sussman A, Pearson CR, Oetzel JG, Wallerstein N. Personal Outcomes in Community-based Participatory Research Partnerships: A Cross-site Mixed Methods Study. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:439-449. [PMID: 32706125 PMCID: PMC7772261 DOI: 10.1002/ajcp.12446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Community-based participatory research (CBPR) has been embraced by diverse populations to address health inequities within their communities. CBPR has been shown to produce favorable health outcomes, but little is known about personal outcomes (e.g., individual growth and capacities) resulting from the direct involvement in a CBPR partnership. We empirically examine which CBPR partnerships' processes and practices are associated with personal outcomes. We hypothesize that higher levels of collaborative approaches and adherence to CBPR principles and practices would be associated with personal outcomes. Based on a national cross-site CBPR study, Research for Improved Health, we utilized mixed-method data from a comprehensive community-engagement survey (N = 450) and seven in-depth case studies to explore the hypothesized relationships. Our multivariate mixed-effects model revealed the importance of various partnering practices. Relationship dynamics emerged as key predictors including the following: respect in the partnership, voice and influence in decision-making among partners, and stewardship. Qualitative findings highlighted individual, partnership, and community-level impacts, within and beyond the partnership. Our findings have implications for CBPR best practices and highlight the potential role of personal outcomes for partnerships' sustainability, long-term outcomes, and health equity research.
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Affiliation(s)
| | - Andrew Sussman
- Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Cynthia R Pearson
- Indigenous Wellness Research Institute, University of Washington, Seattle, WA, USA
| | - John G Oetzel
- School of Management and Marketing, University of Waikato, Hamilton, New Zealand
| | - Nina Wallerstein
- College of Population Health, Center for Participatory Research, University of New Mexico, Albuquerque, NM, USA
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Dissemination of an American Indian Culturally Centered Community-Based Participatory Research Family Listening Program: Implications for Global Indigenous Well-Being. GENEALOGY 2020. [DOI: 10.3390/genealogy4040099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We introduce a culture-centered indigenous program called the Family Listening Program (FLP), which was developed through a long-standing community-based participatory research (CBPR) partnership involving tribal research teams (TRTs) from three American Indian communities (Apache, Navajo, and Pueblo) with the University of New Mexico’s Center for Participatory Research (UNM-CPR). This paper provides background information on the TRT/UNM-CPR multi-generational FLP intervention funded by the National Institute on Drug Abuse and how it is poised to take the next steps of dissemination and implementation (D&I). In preparing for the next steps, the TRT/UNM-CPR team piloted two FLP dissemination activities, first at the state-level and then nationally; this paper describes these activities. Based on the learnings from the pilot dissemination, the TRT/UNM-CPR team developed an innovative D&I model by integrating a community-based participatory research culture-centered science (CBPR-CCS) approach with the Interactive Systems Framework (ISF) to examine the uptake, cultural acceptance, and sustainability of the FLP as an evidence-based indigenous family program.
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Wallerstein N, Oetzel JG, Sanchez-Youngman S, Boursaw B, Dickson E, Kastelic S, Koegel P, Lucero JE, Magarati M, Ortiz K, Parker M, Peña J, Richmond A, Duran B. Engage for Equity: A Long-Term Study of Community-Based Participatory Research and Community-Engaged Research Practices and Outcomes. HEALTH EDUCATION & BEHAVIOR 2020; 47:380-390. [PMID: 32437293 PMCID: PMC8093095 DOI: 10.1177/1090198119897075] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Community-based participatory research (CBPR) and community-engaged research have been established in the past 25 years as valued research approaches within health education, public health, and other health and social sciences for their effectiveness in reducing inequities. While early literature focused on partnering principles and processes, within the past decade, individual studies, as well as systematic reviews, have increasingly documented outcomes in community support and empowerment, sustained partnerships, healthier behaviors, policy changes, and health improvements. Despite enhanced focus on research and health outcomes, the science lags behind the practice. CBPR partnering pathways that result in outcomes remain little understood, with few studies documenting best practices. Since 2006, the University of New Mexico Center for Participatory Research with the University of Washington's Indigenous Wellness Research Institute and partners across the country has engaged in targeted investigations to fill this gap in the science. Our inquiry, spanning three stages of National Institutes of Health funding, has sought to identify which partnering practices, under which contexts and conditions, have capacity to contribute to health, research, and community outcomes. This article presents the research design of our current grant, Engage for Equity, including its history, social justice principles, theoretical bases, measures, intervention tools and resources, and preliminary findings about collective empowerment as our middle range theory of change. We end with lessons learned and recommendations for partnerships to engage in collective reflexive practice to strengthen internal power-sharing and capacity to reach health and social equity outcomes.
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Affiliation(s)
| | | | | | | | | | - Sarah Kastelic
- National Indian Child Welfare Association, Portland, OR, USA
| | | | | | | | - Kasim Ortiz
- University of New Mexico, Albuquerque, NM, USA
| | | | - Juan Peña
- University of New Mexico, Albuquerque, NM, USA
| | - Alan Richmond
- Community Campus Partnerships for Health, Raleigh, NC, USA
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