Medical Advocacy among Latina Women Diagnosed with Breast Cancer

Medical advocacy has continued to significantly impact quality of life and survivorship outcomes among Latina breast cancer survivors in the United States. However, little is known about the unique experiences of Latina survivors, including the perceived value, process, and context in which they practice medical advocacy. To help address this gap, we conducted a qualitative, secondary analysis of semi-structured focus groups with 18 Latina breast cancer survivors from Chicago, Illinois. Eligible women had to self-identify as (1) female, (2) Latina, (3) 18 years or older, and (4) having a breast cancer diagnosis 5 years ago or more. In total, 61% of participants were 50-59 years old, 83% were born in Mexico, and 100% spoke Spanish. The three emergent themes from the focus groups were (1) the cultural need for Latina advocates and support groups; (2) the process and experiences of becoming a community advocate within Latine culture; and (3) the cultural contexts for advocacy by Latina breast cancer survivors. Latina survivor advocates share strengths of receiving ongoing health education, peer support, and access to resources when being linked to a support group furthering their exposure to role models, increasing their awareness of opportunities in medical advocacy, and providing an entry to participate in medical advocacy.

Building Research for Academic and Community Equity (BRACE): A Toolkit for Community Research Partnerships

Health and human service community organizations and researchers have important insights and resources to share with each other, yet often have very little information about how to interact in meaningful and equitable ways. Conceptualized by and for community organization professionals wanting to equitably interact with academic researchers, BRACE (Building Research for Academic and Community Equity) is a toolkit easily accessible to community members which explains research information and jargon in clear terms. BRACE uses community-based participatory research (CBPR) principles to guide both community organizations and academics seeking to partner on research. The BRACE toolkit's two main sections focus on identifying ideal aspects of community-academic research partnerships and writing grant proposals. Tools such as BRACE have the potential to increase the impact of community-engaged research by providing concrete guides for building partnerships and potentially sustaining them through grant funding.

A Scoping Review on the Effects of COVID-19 on Syringe Service Programs in the United States

The COVID-19 pandemic has had worldwide impacts, including disrupting community services. One interrupted service was syringe service programs (SSPs), community-established initiatives that provide sterile supplies and aid in overcoming addiction in drug-using participants. In the United States (U.S.), SSPs have been key in combating the recent opioid use crisis and associated infections such as the human immunodeficiency virus (HIV) and hepatitis C. While some published reports on the pandemic's overall impacts on SSPs exist, certain aspects such as operational changes and repercussions on staff and participants may still be lacking. Information about the impact of interrupted SSP services due to the pandemic may provide insight into how to prepare to mitigate similar outcomes during possible future health outbreaks. The aim of this scoping review was thus to explore the effects of the COVID-19 pandemic on the operations, staff, and participants of SSPs in the U.S. The initial search of the databases PubMed, Embase, and Web of Science with selected keywords yielded 117 articles published in English between January 1, 2020, and August 31, 2022. After screening each article for study eligibility, 11 articles were included in the final review. Of the seven articles exploring SSP operational impacts from the pandemic, five acknowledged that mitigation strategies influenced functions, seven highlighted supply changes, and four emphasized the resulting staffing changes. Four studies inspected the pandemic's impacts on SSP participants, which included two articles highlighting participants' struggles with isolation and loneliness, one referencing the fear of exposure to the SARS-CoV-2 virus, and two examining the overall negative psychological effects experienced during this time. SSPs in various settings and regions across the U.S. experienced changes due to the COVID-19 pandemic. Many of these modifications negatively impacted operations, staffing, and participant relationships. Examining the issues that individual SSPs encountered highlights opportunities for structured solutions for the present and in the case of future infectious disease outbreaks. With the severity of the opioid use crisis in the U.S. and the dependence on SSPs for its mitigation, future work in this space should be prioritized.

Improving Cancer Survivorship Care for Latino Adolescent, Young Adult Survivors through Community-Partnered Participatory Research

Background

Minority adolescent and young adult (AYA) cancer survivors experience disparities in receipt of survivorship care.

Objective

This study describes the infrastructure of a community-partnered participatory research (CPPR) project between a community-based organization and a National Cancer Institute (NCI)-designated cancer center to develop culturally-tailored interventions to improve Latino AYA cancer survivor knowledge regarding their need for survivorship care.

Methods

Research team participants included the community organization and NCI cancer center directors, a research coordinator, a community liaison, and cross-training program interns. Through use of Jones's theoretical framework, additional stakeholders from academic and community settings were identified and invited to participate in the research team. A process evaluation and qualitative interviews were conducted to assess equal partnership between community and academic stakeholders and determine if the infrastructure followed the five core principles of CPPR. A grounded theory approach was used to analyze qualitative data.

Conclusions

CPPR between an NCI-designated cancer center and a community-based organization is a new research model for conducting minority AYA cancer survivor outreach. Open communication was critical in engaging the Latino community to discuss their survivorship needs. Community stakeholders were key to infrastructure success through fostering a cohesive partnership with and acting as the voice of the Latino community. Implementing a cross-training program promoted continued engagement of community members with academic partners. Proper infrastructure development is critical to building successful research partnerships in order to develop culturally-tailored interventions to improve survivorship care knowledge.

Implementation and Evaluation of a Dual-Track Research Training Program for Community Members and Community-Based Organizations

BACKGROUND

It is a public health priority to increase community research participation to improve health outcomes and eliminate health disparities. There is a need for effective research training programs that build community stakeholders' capacity to engage as equitable partners.

OBJECTIVES

To describe the collaborative process of implementing and evaluating a dual-track community research training program-Meharry Vanderbilt Community Engaged Research Core-Community Research Training Program (MVC-CRT) Program-and present participant evaluations.

METHODS

The MVC-CRT is a six-session community-based organization (CBO) curriculum and a three-session community member (CM) curriculum, based on needs identified by various community stakeholders, that was piloted in 2016. Immediately post-training, an outcome evaluation (surveys) was used to measure trainees' confidence relative to 30 learning objectives for the combined training sessions (e.g., Introduction to research), satisfaction in preparing them for research roles, and impact on research activities (e.g., building sustainable partnerships). 2 and 3 months after training, a process evaluation (focus groups) was used to assess each session's flow, materials, group discussions, and facilitators.

RESULTS

Trainees' immediate post-training confidence increased or remained the same across 26 of 30 learning objectives. Two to 3 months after training, trainees reported sustained confidence, perceived increased knowledge, and increased intentions to engage in or improve research activities. All participants were satisfied with the program and felt better prepared for research roles.

CONCLUSIONS

Tailored community research training may result in positive outcomes that can ultimately increase community capacity to be equitable partners in research in support of efforts to improve health outcomes and eliminate health disparities.

Training Academic and Community Investigator Teams for Community-Engaged Research: Program Development, Implementation, Evaluation and Replication

BACKGROUND

Community-engaged research (CEnR) is an approach to conducting research that actively involves both academic and community partners. Yet many academic researchers have limited knowledge of emerging science and processes for effectively engaging communities and community members are often subjects of research with limited knowledge and participation in the development and implementation of research.

OBJECTIVES

The purpose of this article is to explore two CEnR research training programs, both funded by National Institutes of Health (NIH), for the explicit purpose of facilitating translational science. South Carolina developed the initial program that served as a model for the Delaware program.

METHODS

Information is presented about how these two programs recruit, develop, and support academic and community partnerships, as well as how each uses mentorship, funding, and structured training programs for successful CEnR with an emphasis on community-based participatory research (CBPR). The development of each program, the funding source, selection process, team requirements and expectations, educational content, evaluation and outcomes are described.

RESULTS

Both programs have increased the number and quality of community-engaged researchers, with 40 academic and community dyad partnerships participating in the training and successfully completing pilot projects. Evaluations reveal the development of effective academic- community partnerships for research with successful dissemination and return on investment (ROI) ranging from $9.72 to $41.59 for each dollar invested in the projects.

CONCLUSIONS

Research teams have demonstrated improvements in developing and using CEnR and CBPR approaches. These intermediate measures of success demonstrate the need for similar programs that provide training, preparation, and support to those interested in CEnR.

The Development of a Measure of Alaska Native Community Resilience Factors through Knowledge Co-production

BACKGROUND

The Alaska Native Community Resilience Study (ANCRS) is the central research project of the Alaska Native Collaborative Hub for Research on Resilience (ANCHRR), one of three American Indian and Alaska Native (AIAN) suicide prevention hubs funded by the National Institute of Mental Health.

OBJECTIVE

This paper describes the development of a structured interview to identify and measure community-level protective factors that may reduce suicide risk among youth in rural Alaska Native communities.

METHODS

Multilevel, iterative collaborative processes resulted in: a) expanded and refined constructs of community-level protection, b) clearer and broadly relevant item wording, c) respectful data collection procedures, and d) Alaska Native people from rural Alaska as primary knowledge-gathering interviewers.

LESSONS LEARNED

Moving beyond engagement to knowledge co-production in Alaska Native research requires flexibility, shared decision-making and commitment to diverse knowledge systems; this can result in culturally attuned methods, greater tool validity, new ways to understand complex issues and innovations that support community health.

Decades of Doing: Indigenous Women Academics Reflect on the Practices of Community-Based Health Research

It has been several decades since the establishment of Ownership, Control, Access, and Possession (OCAP®) and the proliferation of work on Indigenous research ethics. Most of this dialogue emerged because of egregious health research practices in Indigenous communities and has since taken a foothold across all disciplines. Community-engaged research in Indigenous communities is challenging. It is important to reflect on some of the early ethical and methodological debates, which shape how we currently work with communities. This research describes the themes that emerged when two Indigenous scholars interviewed their Indigenous university-based colleagues who work in Indigenous health. These interviews uncovered four critical themes that were prominent and related specifically to understanding research ethics in Indigenous health research specifically. These themes included research in relationship, creating partnerships and negotiating across systems, self-determination applied to research, and community-engaged research.

The Church Bridge Project: An Academic-Community Perspective of a Church-Based Weight Management Pilot Intervention among Young Adult African Americans

BACKGROUND

Churches are effective community partners and settings to address weight management among African Americans. There is limited information on the use of churches to reach young adult populations and church collaborations with primary care clinics.

OBJECTIVES

The Church Bridge Project represents a community-academic partnership that presents the recruitment process of a church-based weight management intervention and describes baseline data of participants recruited from churches and primary care providers. We also discuss research contributions, challenges and limitations, study applicability, and practice implications from an academic and community perspective.

METHODS

Church leaders were involved in the entire research process. The theory-driven intervention included 12 diabetes prevention program-adapted education and motivational interviewing (MI)-guided sessions. Participants were recruited through primary care providers and church leaders. Demographics, medical and weight history, stage of change for weight loss, social support, and self-efficacy for diet and physical activity, weight, and girth circumferences were measured. Baseline descriptive data were analyzed.

RESULTS

Of 64 potential participants, 42 (65.6%) were enrolled in the study and 16 (25.0%) completed baseline data collection. No participants were recruited through primary care providers. Recruited participants were similar to the target population except for being all obese and mostly female. The mean ± SD age of participants was 34.31 ± 8.86 years with most reporting having more than a high school education (n = 14 [87.5%]), individual yearly income of less than $59,000 (n = 12 [75.0%]), and been married or living with a partner (n = 9 [56.3%]). Most reported a history of hypertension and an immediate family history of diabetes and hypertension. Most participants were classified as class III obesity.

CONCLUSIONS

Young adults and primary care providers are difficult to engage in church-based interventions. Church leaders were comfortable with a collaborate model for decision making, but not an empower model. Churches remain a successful method to reach African Americans; however, more research is needed to motivate young adults to participate in health intervention research.

A Retrospective on the Vision for Progress in Community Health Partnerships: Research, Education, and Action

The organizers founded Progress in Community Health Partnerships with a commitment to improving our understanding of community-based participatory research (CBPR) and its use in community-academic/institutional health partnerships. Following Rogers's Diffusion of Innovations, they reasoned that expanded adoption would occur through academic and community partner recognition of CBPR's relative advantage over previous approaches; its compatibility with the values, past experience and needs of potential adopters; its ease of understanding and use; its capacity for experimentation and refinement; and its production of observable results. We now assess the journal's progress toward realizing the vision, as well as issues and problems the organizers identified. We map the journal's content over its first decade onto the initial vision by examining the record of submissions and publications across the eight types of articles and the journal's record of rejections and publications. In remembering that Rogers's study of innovations requires both technical and social change, we discuss the difference between understanding how to do something and actually putting an innovation into action that becomes standard practice at both individual and systemic levels. We observe that the large number of Original Research and Works-in-Progress/Lessons Learned manuscripts, submitted and published, reflect traditional expectations for faculty research productivity. We suggest that sustainability, which rated of lower importance within the initial vision, has gained in importance among community and academic partners; however, it will gain added attention only with changed university expectations of researchers. We further suggest that the study of partnerships involved in researching and improving public health should be expanded beyond the current focus on CBPR.

A Culture of Understanding: Reflections and Suggestions from a Genomics Research Community Board

There has been limited community engagement in the burgeoning field of genomics research. In the wake of a new discovery of genetic variants that increase the risk of kidney failure and are almost unique to people of African ancestry, community and clinical leaders in Harlem, New York, formed a community board to inform the direction of related research. The board advised all aspects of a study to assess the impact of testing for these genetic variants at primary care sites that serve diverse populations, including explaining genetic risk to participants. By reflecting on the board's experiences, we found that community voices can have tangible impact on research that navigates the controversial intersection of race, ancestry, and genomics by heightening vigilance, fostering clear communication between researchers and the community, and encouraging researchers to cede some control. Our reflections and work provide a strong justification for longitudinal community partnerships in genomics research.

Much Ventured, Much Gained: Community-Engaged Data Collection by Adolescents and Young Adults

BACKGROUND

Community-engaged data collection offers an important opportunity to build community capacity to harness the power of data and create social change.

OBJECTIVES

To share lessons learned from engaging 16 adolescents and young adults from a partner community to collect data for a public opinion survey as part of a broader community-based participatory research (CBPR) project.

METHODS

We conducted an analysis of archival documents, process data, and an assessment of survey assistants' experiences.

LESSONS LEARNED

High-quality data were collected from a hard-to-reach population. Survey assistants benefited from exposure to research and gained professional skills. Key challenges included conducting surveys in challenging environments and managing schedule constraints during the school year. The tremendous investment made by project partners was vital for success.

CONCLUSIONS

Investments required to support engaged data collection were larger than anticipated, as were the rewards, prompting greater attention to the integration of adolescents and young adults in research efforts.

CBPR-Informed Recruitment and Retention Adaptations in a Randomized Study of Pap Testing Among Pacific Islanders in Southern California

BACKGROUND

Pacific Islanders (PIs) experience high cervical cancer rates in the United States. Stage of diagnosis is also later for PIs than non-Hispanic Whites. The Pap test is severely underutilized among PIs: only 71% of Asian American and Pacific Islander women age 25 years or older received a Pap test within the last 3 years (U.S. average, 82%). Community-based participatory research (CBPR) is increasingly seen as an essential approach in designing and conducting culturally relevant and appropriate studies that reduce cancer incidence and other health disparities among minority and other medically underserved populations.

PURPOSE

The purpose of this article is to describe the lessons learned thus far regarding the identification, recruitment, and retention of PI community organizations and members into a CBPR-informed, randomized, community trial promoting Pap testing.

METHODS

This 5-year study used CBPR to develop and test the efficacy of a social support intervention for Chamorro, Samoan, and Tongan women to increase Pap testing in southern California. Eligible women were between the ages of 21 and 65, and married or in a long-term relationship with a man for at least 5 years. Women and their husbands or significant others received a 2-hour, culturally tailored workshop that include a group activity, information on Pap testing, a video, and corresponding materials. Comparison participants received a brochure about Pap testing. Three waves of data are collected from all participants: pretest (before workshop or brochure), posttest 1 (immediately after workshop or brochure), and posttest 2 (6 months follow-up).

RESULTS

Of the 76 organizations approached to participate in the study, 67 (88.2%) eventually agreed to participate. Thus far, 473 women and 419 men completed the study pretest, post-test, education, and 6-month follow-up. Only 242 women and 204 men of the eligible participants have completed the follow-up survey (63.5% of women and 60.5% of men retained after 6 months).

LESSONS LEARNED

The main strategy to overcome initial recruitment challenges was study staff persistence, because they averaged five contacts with each church or clan leader before receiving confirmation that an educational session can be scheduled. Personal connections provided an introduction to the most appropriate church or clan leader. Other efforts for retention include creation of an online version of the survey, re-attending church services, and creating special events organized around clan activities.

CONCLUSIONS

Although CBPR improves the cultural competence and relevance of study activities for ethnically diverse populations, selected past research shows that it does not ensure that such designs overcome all of the unique challenges in ethnically diverse communities. PI-specific organizational recruitment and individual retention is influenced by study issues and cultural factors in each community.

Evaluating community-based participatory research to improve community-partnered science and community health

BACKGROUND

Since 2007, the National Congress of American Indians (NCAI) Policy Research Center (PRC) has partnered with the Universities of New Mexico and Washington to study the science of community-based participatory research (CBPR). Our goal is to identify facilitators and barriers to effective community-academic partnerships in American Indian and other communities, which face health disparities.

OBJECTIVES

We have described herein the scientific design of our National Institutes of Health (NIH)-funded study (2009-2013) and lessons learned by having a strong community partner leading the research efforts.

METHODS

The research team is implementing a mixed-methods study involving a survey of principal investigators (PIs) and partners across the nation and in-depth case studies of CBPR projects.

RESULTS

We present preliminary findings on methods and measures for community-engaged research and eight lessons learned thus far regarding partnership evaluation, advisory councils, historical trust, research capacity development of community partner, advocacy, honoring each other, messaging, and funding.

CONCLUSIONS

Study methodologies and lessons learned can help community-academic research partnerships translate research in communities.

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

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

Understanding body image in African American and Caucasian first-graders: a partnership with the YMCA

BACKGROUND

Research suggests that body dissatisfaction can develop by first grade or 6 years of age. Few studies have examined the relationship between parental body image factors on child body image among this population using a CBPR approach.

OBJECTIVE

We sought to examine parental influence on body image in African American and Caucasian first-graders through a community-based participatory research (CBPR) partnership with the YMCA of Metropolitan Washington, DC.

METHODS

Quantitative data were collected by after-school teachers and academic researchers. Children were administered a silhouette measure to assess body image. Body image and eating behavior measures were given to parents. Correlational and descriptive analyses were employed to examine the association and characteristics of child body image factors.

RESULTS

Participants were 58 child-parent dyads attending YMCA after-school programs in the Washington, DC, area. Descriptive analyses found significant body dissatisfaction among first graders. Only 12.1% of first graders were satisfied with their bodies, and among the 38 children of normal weight, 89.5% were dissatisfied with their current body size. No significant correlations emerged between child body image and parental eating factors. However, correlations did emerge between child and parent body image indices.

CONCLUSION

Findings from this study were used to develop programming focused on promoting positive body image and self-esteem for young children in YMCA sites in the DC metro area. Additionally, future studies should further delineate body image among young children and the clinical and educational implications of early onset of body dissatisfaction in this population using a CBPR approach.

Using community-based participatory research to develop a bilingual mental health survey for Latinos

BACKGROUND

Despite rapid growth, Latino communities' mental health needs are unmet by existing services and research. Barriers may vary by geographic locations, but often include language, insurance coverage, immigration status, cultural beliefs, and lack of services.

OBJECTIVES

The aim of this research was development of a cross-sectional instrument to assess the mental health status, beliefs, and knowledge of resources among rural and urban Latinos residing in a Midwestern state.

METHODS

The purpose of this article is to describe the community-based participatory research (CBPR) process of instrument development and lessons learned.

RESULTS

A culturally relevant, 100-item bilingual survey instrument was developed by community and academic partners.

LESSONS LEARNED

Community-based participatory research methods are salient for sensitive health topics and varied research objectives, including instrument development. To ensure cultural and social relevance of research, community participation is crucial at all stages of research, including developing the research question and instrument.

Development and management of a geographic information system for health research in a developing-country setting: a case study from Bangladesh

In the last decade, geographic information systems (GIS) have become accessible to researchers in developing countries, yet guidance remains sparse for developing a GIS. Drawing on experience in developing a GIS for a large community trial in rural Bangladesh, six stages for constructing, maintaining, and using a GIS for health research purposes were outlined. The system contains 0.25 million landmarks, including 150,000 houses, in an area of 435 sq km with over 650,000 people. Assuming access to reasonably accurate paper boundary maps of the intended working area and the absence of pre-existing digital local-area maps, the six stages are: to (a) digitize and update existing paper maps, (b) join the digitized maps into a large-area map, (c) reference this large-area map to a geographic coordinate system, (d) insert location landmarks of interest, (e) maintain the GIS, and (f) link it to other research databases. These basic steps can produce a household-level, updated, scaleable GIS that can both enhance field efficiency and support epidemiologic analyses of demographic patterns, diseases, and health outcomes.