Reaching Consensus on Principles of Stakeholder Engagement in Research

BACKGROUND

Stakeholder-engaged research is an umbrella term for the types of research that have community, patient, and/or stakeholder engagement, feedback, and bidirectional communication as approaches used in the research process. The level of stakeholder engagement across studies can vary greatly, from minimal engagement to fully collaborative partnerships.

OBJECTIVES

To present the process of reaching consensus among stakeholder and academic experts on the stakeholder engagement principles (EPs) and to identify definitions for each principle.

METHODS

We convened 19 national experts, 18 of whom remained engaged in a five-round Delphi process. The Delphi panel consisted of a broad range of stakeholders (e.g., patients, caregivers, advocacy groups, clinicians, researchers). We used web-based surveys for most rounds (1-3 and 5) and an in-person meeting for round 4. Panelists evaluated EP titles and definitions with a goal of reaching consensus (>80% agreement). Panelists' comments guided modifications, with greater weight given to non-academic stakeholder input.

CONCLUSIONS

EP titles and definitions were modified over five Delphi rounds. The panel reached consensus on eight EPs (dropping four, modifying four, and adding one) and corresponding definitions. The Delphi process allowed for a stakeholder-engaged approach to methodological research. Stakeholder engagement in research is time consuming and requires greater effort but may yield a better, more relevant outcome than more traditional scientist-only processes. This stakeholder-engaged process of reaching consensus on EPs and definitions provides a key initial step for the content validation of a survey tool to examine the level of stakeholder engagement in research studies.

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.

Toward Health Equity: A National Study of Promising Practices in Community-Based Participatory Research

OBJECTIVES

In the first nationwide study of community- academic research partnerships, we identified contextual and partnership practices that were significantly correlated with successful partnership outcomes guided by a community-based participatory research (CBPR) conceptual model.

METHODS

Data collection included three stages: 294 community-engaged research (CEnR) projects in 2009 identified from federally funded grant databases; 200 (68.0%) principal investigators (PI) completed a key informant survey that included measures of power/resource sharing and structural characteristics of projects; 312 (77.2% of invited) community partners and 138 PI (69.0% of invited) responded to a survey including research context, process, and outcome measures.

RESULTS

Context and process correlates accounted for 21% to 67% of the variance in the specific outcomes. Seven categories of research partnership practices were positively associated with successful synergy, capacity, and health outcomes: power sharing, partnership capacity, bridging social capital, shared values, community involvement in research, mutuality, and ethical management.

CONCLUSIONS

Through empirical testing of an innovative, multidisciplinary CBPR model, key context and process practices were identified that confirm the positive impact of partnership evaluation and self-reflection on research outcomes. Further, these findings provide academic and other key stakeholders with real-world practical recommendations to engage agencies, groups, and individuals who suffer most from inequities and may have unrecognized or indigenous knowledge, experience, and leadership to contribute to health and social research and to the creation of paths to wellness.

Implementing the Chronic Care Model for Opioid and Alcohol Use Disorders in Primary Care

BACKGROUND

Effective treatments for opioid and alcohol use disorders (OAUD) are available, yet only a small percentage of those needing treatment receive it.

OBJECTIVES

This paper describes a collaborative planning and development process used by researchers and community providers to apply the chronic care model to the delivery of treatment for OAUD in primary care. The goal was to develop and implement an intervention that would support the delivery of brief psychotherapy and medication-assisted treatment (MAT).

METHODS

We used focus groups and interviews to identify barriers and facilitators, and organized the results using the chronic care model. We then identified implementation strategies, the intended organizational changes, and the materials necessary to carry out each strategy, and pilot-tested the process.

RESULTS AND CONCLUSIONS

We describe the methods and outcomes of the collaborative planning and development process, and discuss implications of the work for the integration of substance use treatment with primary care.

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.

"Tension" in South Asian women: developing a measure of common mental disorder using participatory methods

BACKGROUND

Although common mental disorder (CMD) is highly prevalent among South Asian immigrant women, they rarely seek mental treatment. This may be owing in part to the lack of conceptual synchrony between medical models of mental disorder and the social models of distress common in South Asian communities. Furthermore, common mental health screening and diagnostic measures may not adequately capture distress in this group. Community-based participatory research (CBPR) is ideally suited to help address measurement issues in CMD as well as to develop culturally appropriate treatment models.

OBJECTIVES

To use participatory methods to identify an appropriate, culturally specific mental health syndrome and develop an instrument to measure this syndrome.

METHODS

We formed a partnership between researchers, clinicians, and community members. The partnership selected a culturally specific model of emotional distress/illness, "tension," as a focus for further study. Partners developed a scale to measure Tension and tested the new scale on 162 Bangladeshi immigrant women living in the Bronx.

RESULTS

The 24-item "Tension Scale" had high internal consistency (α = 0.83). On bivariate analysis, the scale significantly correlated in the expected direction with depressed as measured by the Patient Health Questionnaire (PHQ-2), age, education, self-rated health, having seen a physician in the past year, and other variables.

CONCLUSIONS

Using participatory techniques, we created a new measure designed to assess CMD in an isolated immigrant group. The new measure shows excellent psychometric properties and will be helpful in the implementation of a community-based, culturally synchronous intervention for depression. We describe a useful strategy for the rapid development and field testing of culturally appropriate measures of mental distress and disorder.

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.

Collaboration strategies in nontraditional community-based participatory research partnerships: lessons from an academic−community partnership with autistic self-advocates

BACKGROUND

Most community-based participatory research (CBPR) projects involve local communities defined by race, ethnicity, geography, or occupation. Autistic self-advocates, a geographically dispersed community defined by disability, experience issues in research similar to those expressed by more traditional minorities.

OBJECTIVES

We sought to build an academic-community partnership that uses CBPR to improve the lives of people on the autistic spectrum.

METHODS

The Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) includes representatives from academic, self-advocate, family, and professional communities. We are currently conducting several studies about the health care experiences and well-being of autistic adults.

LESSONS LEARNED

We have learned a number of strategies that integrate technology and process to successfully equalize power and accommodate diverse communication and collaboration needs.

CONCLUSIONS

CBPR can be conducted successfully with autistic self-advocates. Our strategies may be useful to other CBPR partnerships, especially ones that cannot meet in person or that include people with diverse communication needs.

The development of a community-based family asthma management intervention for Puerto Rican children

BACKGROUND

Puerto Rican children maintain disproportionately high asthma prevalence rates and effective asthma management interventions are needed.

OBJECTIVES

This article describes how community-based participatory research (CBPR) was implemented in the development of a culturally tailored family asthma management intervention for Puerto Rican children: CALMA (a Spanish acronym for Take Control, Empower Yourself, and Achieve Asthma Management).

METHOD

CALMA was developed according to CBPR principles and contemporary asthma guidelines through the collaboration of diverse members of the local, professional, and medical communities, academia, and local government. All group members contributed unique perspectives, making CALMA's development a collaborative effort.

LESSONS LEARNED

The CALMA community dealt with challenges in both incorporating and managing a diverse group of stakeholders and maintaining equity in decision making power. However, the community maintained strengths, such as incorporating culturally accepted remedies and addressing culturally specific myths in the intervention, as well as having the medical community directly involved in overseeing the accuracy of the intervention.

CONCLUSION

A CBPR approach enhanced the cultural sensitivity of the intervention as well as its potential for sustainability.

Evaluation of a partnership approach to translating research on breast cancer and the environment

BACKGROUND

The growing literature on community-based participatory research (CBPR) suggests that a participatory approach benefits science in important ways. However there have been few formal evaluations of a CBPR approach itself, and few standards developed to assist in such efforts.

OBJECTIVES

This evaluation used CBPR guidelines developed by Green and colleagues to evaluate the participatory approach of the Community Outreach and Translation Core (COTC) of the Bay Area Breast Cancer and the Environment Research Center (BABCERC) in translating scientific findings from two key projects to the public.

METHOD

To assess key stakeholders' perceptions of alignment between the projects and the guidelines, four COTC members, four researchers, and four community members rated the projects on each of the 26 guidelines. These data were triangulated with transcripts from interviews with the same participants and a focus group with a subset of the participants.

RESULTS

The participatory approach by the COTC resulted in many important benefits including improved relationships among diverse stakeholders, knowledge generation, increased sensitivity and propriety of the research, and increased community support of research. However, several atypical features of this collaboration-for example, the basic and etiological nature of the science being undertaken, and the multiple communities (lay and activist/advocate) involved-resulted in different levels and qualities of participation among stakeholders.

CONCLUSIONS

Further research should focus on the adaptation of participatory research principles for different kinds of community partners and on the development and refinement of standards and tools to assist in evaluating the process and outcome of participatory research.

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.