Community-based participatory research: implications for public health funding

Patient powered research: an approach to building capacity for a hardly reached patient population to engage in cancer research

BACKGROUND

Participating in clinical trials is a metric of high-quality cancer care and improves survival. However, Black individuals with cancer are less likely to be enrolled in clinical trials and experience a disproportionate burden of cancer mortality compared to Whites. Patient-engaged research is one potential strategy to address racial inequities in clinical trials, but little is known about best practices for engaging Black individuals and communities impacted by cancer in research partnerships.

METHODS

We used a community engaged research approach to establish a patient advisory council (PAC) representative of the patient population served by a safety net hospital cancer center. We outline the process of establishing the PAC and the lessons learned.

RESULTS

The inaugural PAC included 7 members representative of the cancer center's patient demographics. PAC members developed a patient centered vision, mission and action plan. PAC and community-academic research partners experienced the transformative power of centering the lived experiences of patients of color to promote health equity in cancer research.

CONCLUSION

Establishing a patient advisory council at a safety net hospital cancer care center provided a platform for engaging a hardly reached population in patient centered research.

Key performance indicators of cooperative planning processes: Case study results from German sport science and physical activity promotion projects

Objective

The aim of this study was to map the phases and individual steps of the cooperative planning process, a specific participatory approach frequently used in German sports and physical activity promotion, and to explore facilitators, barriers, and challenges experienced by those leading its implementation in selected projects.

Background

More than half of the global population is not physically active enough. Therefore, the demand for more effective physical activity programs is growing. Participatory-based interventions, using the cooperative planning process, offer the potential to plan new programs that match population group and setting characteristics. This approach was extensively applied in German sports and physical activity fields, serving as a mechanism to develop and implement specific measures to change the population’s behaviour. We analysed four German empirical projects promoting sports and physical activity to identify how the approach was adapted to each project, which phases were considered, and which key performance indicators enhanced (facilitators), exacerbated (barriers), or challenged the process.

Methods

This study used a mixed-methods approach, including a systematic analysis of documents (n = 10) and in-depth, semi-structured interviews (n = 4) with the empirical projects’ scientific members.

Results

The cooperative planning process was shaped across its phases by several facilitators, challenges, and barriers. Diverse assessment procedures and recruitment tools can facilitate preparation of the process, while moderation requires particular attention during the development phase. Identifying a champion in the transition subphase and providing ongoing scientific counselling can assure the implementation of an action plan with tailored measures for sports and physical activity promotion.

Conclusions

This study contributes to a better understanding of the complexity of the cooperative planning approach and, therefore, flexibility in sports and physical activity promotion projects. Many preparation actions, several challenges in the planning process, and a critical transition in implementation responsibilities should be considered by future projects intending to adopt the approach.

A mixed-methods longitudinal study of Marshallese infant feeding beliefs and experiences in the United States: a study protocol

BACKGROUND

Arkansas has the largest population of Marshallese Pacific Islanders residing in the continental United States. Marshallese are disproportionately burdened by poorer maternal and infant health outcomes. Exclusive breastfeeding can prevent or help mitigate maternal and infant health disparities. However, exclusive breastfeeding among United States Marshallese communities remains disproportionately low, and the reasons are not well documented. This paper describes the protocol of a mixed-methods concurrent triangulation longitudinal study designed to explore the beliefs and experiences that serve as barriers and/or facilitators to exclusive breastfeeding intention, initiation, and duration among Marshallese mothers in northwest Arkansas.

METHODS

The mixed-methods design collects qualitative and quantitative data during simultaneous data collection events, at third trimester, six weeks postpartum, and six months postpartum. Quantitative and qualitative data will be analyzed separately and then synthesized during the interpretation phase. The research team will disseminate results to study participants, research stakeholders, the broader Marshallese community, and fellow researchers.

DISCUSSION

Findings and results will be presented in subsequent manuscripts upon completion of the study. This study will be an important first step to better understand beliefs and experiences to exclusive breastfeeding intention, initiation, and duration in this community and will inform tools and interventions to help improve health outcomes. The study will also aid in filling the gap in research and providing essential information on the infant feeding beliefs and barriers among a Marshallese community in Arkansas.

Participatory Methodologies With Adolescents: A Research Approach Used to Explore Structural Factors Affecting Alcohol Use and Related Unsafe Sex in Tanzania

Multiple methodological approaches have been used to explore adolescent alcohol use and related sexual behaviors, ranging from surveys to assessments of alcohol outlet density. Although surveys can capture the extent of alcohol use, they do not allow for a contextualized understanding of young people's voiced experiences with alcohol, including sociocultural, gendered and environmental pressures to consume, and related engagement in sex. The mapping of alcohol outlets provides physical density information, but infrequently from youths' perspectives. Traditional qualitative methods like in-depth interviews and focus group discussions do allow for a more nuanced understanding of adolescents' experiences, but they can be limited by the use of semi-structured guides that may negatively impact the fluidity of discussion. We seek to contribute to the methodological approaches utilized with adolescents by demonstrating how contextualized data were captured from Tanzanian adolescents' experiences of alcohol and sex, which are sensitive topics in many African countries. We collected data in secondary schools and youth centers across four sites in Dar es Salaam, the largest and most diverse city in Tanzania. As a complement to in-depth interviews, archival reviews, and a systematic mapping of alcohol availability, participatory methodologies such as photovoice, story writing, and drawing allowed Tanzanian youth to offer more honest, descriptions of lived experiences with their physical and social environment in relation to alcohol use and related sexual behavior patterns. Through participatory methods, study participants were able to discuss behaviors that are viewed as social transgressions, sensitive topics like violence in relation to sex, and views around their own self-agency. The use of a methodological toolkit including participatory methodologies enabled youth to trust the researchers and share sensitive information in a relatively short period of time, overcoming some of the challenges of traditional qualitative methods.

Deliberations with American Indian and Alaska Native People about the Ethics of Genomics: An Adapted Model of Deliberation Used with Three Tribal Communities in the United States

BACKGROUND

This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.

METHODS

We adapted democratic deliberation, an approach to stakeholder engagement, for use with three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.

RESULTS

A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.

CONCLUSION

The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described.

The development and psychometric evaluation of the Survey of Obstructive Sleep Apnea Functional Health Literacy

OBJECTIVE AND OBJECTIVE

Obstructive Sleep Apnea (OSA) is a highly prevalent disorder that disparately affects racial/ethnic minorities. OSA functional health literacy can contribute to health disparities. Documenting poor OSA functional health literacy is needed to inform research agendas, policy, and advocacy efforts. The objective of this study is to develop a scale for measuring OSA functional health literacy among diverse audiences and a variety of reading levels and to ascertain its reliability and validity.

METHODS

Development of the 18-item Survey of OSA Functional Health Literacy (SOFHL) was guided by literature review and input from experts. A convenience sample of persons enrolled in a clinical trial completed the survey (n=194). The psychometric evaluation was conducted using factor analysis to identify the number of dimensions in the SOFHL and their relationship to other domains that are relevant to OSA functional health literacy.

RESULTS

Internal consistency reliability (alpha) was estimated for the resulting scale and correlations with educational attainment and income completed. All respondents were Black and 29% reported average household income less than $10,000 USD. Confirmatory factor analysis provided support for two dimensions: OSA general knowledge (alpha=0.81) and self-efficacy for OSA self-management (alpha=0.71).

CONCLUSIONS

Higher educational attainment and socioeconomic status were associated with better OSA functional health literacy. These results provide preliminary support for the SOFHL, a measure that can be used to assess OSA functional health literacy.

Transcriptomic analyses of black women in neighborhoods with high levels of violence

Chronic stress threatens an individual's capacity to maintain psychological and physiological homeostasis, but the molecular processes underlying the biological embedding of these experiences are not well understood. This is particularly true for marginalized groups, presenting a fundamental challenge to decreasing racial, economic, and gender-based health disparities. Physical and social environments influence genome function, including the transcriptional activity of core stress responsive genes. We studied the relationship between social experiences that are associated with systemic inequality (e.g., racial segregation, poverty, and neighborhood violence) and blood cell (leukocytes) gene expression, focusing on the activation of transcription factors (TF) critical to stress response pathways. The study used data from 68 women collected from a convenience sample in 2013 from the Southside of Chicago. Comparing single, low-income Black mothers living in neighborhoods with high levels of violence (self-reported and assessed using administrative police records) to those with low levels of violence we found no significant differences in expression of 51 genes associated with the Conserved Transcriptional Response to Adversity (CTRA). Using TELiS analysis of promoter TF-binding motif prevalence we found that mothers who self-reported higher levels of neighborhood stress showed greater expression of genes regulated by the glucocorticoid receptor (GR). These findings may reflect increased cortisol output from the hypothalamic-pituitary-adrenal (HPA) axis, or increased GR transcriptional sensitivity. Transcript origin analyses identified monocytes and dendritic cells as the primary cellular sources of gene transcripts up-regulated in association with neighborhood stress. The prominence of GR-related transcripts and the absence of sympathetic nervous system-related CTRA transcripts suggest that a subjective perception of elevated chronic neighborhood stress may be associated with an HPA-related defeat-withdrawal phenotype rather than a fight-or-flight phenotype. The defeat-withdrawal phenotype has been previously observed in animal models of severe, overwhelming threat. These results demonstrate the importance of studying biological embedding in diverse environments and communities, specifically marginalized populations such as low-income Black women.

Ensuring Organization-Intervention Fit for a Participatory Organizational Intervention to Improve Food Service Workers' Health and Wellbeing: Workplace Organizational Health Study

OBJECTIVE

Food-service workers' health and wellbeing is impacted by their jobs and work environments. Formative research methods were used to explore working conditions impacting workers' health to inform intervention planning and implementation and to enhance the intervention's "fit" to the organization.

METHODS

Four qualitative methods (worker focus groups; manager interviews; worksite observations; multi-stakeholder workshop) explored in-depth and then prioritized working conditions impacting workers' health as targets for an intervention.

RESULTS

Prioritized working conditions included: ergonomics; work intensity; career development; and job enrichment. Data revealed necessary intervention mechanisms to enhance intervention implementation: worker and management communication infrastructure; employee participation in intervention planning and implementation; tailored worksite strategies; and ensuring leadership commitment.

CONCLUSIONS

These targeted, comprehensive methods move away from a typical focus on generic working conditions, for example, job demands and physical work environment, to explore those conditions unique to an organization. Thereby, enhancing "intervention-fit" at multiple levels within the company context.

Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol

BACKGROUND

Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources.

OBJECTIVES

This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research.

METHODS

This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI.

CONCLUSIONS

This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.

Exploring the capacity of community-based organisations to absorb health system patient referrals for unmet social needs

This study examines the perspectives, resources, role and services provided by community-based organisations (CBOs) in response to the integration of health and social services to address individual unmet social needs, as well as the impact on organisational carrying capacity related to the ability to receive referrals from health system partners. Mixed methods combining qualitative interviews with 24 organisations and Social Network Analysis with 75 organisations were completed in 2018 in two communities (Denton, TX and Sarasota, FL) with robust examples of health and social systems alignment. Findings suggest that while community organisations are embedded in robust cross-sector networks, the potential increase in referrals from clinical settings is not something they are fully aware of, or prepared for, as evidenced by inadequate funding models, misalignment between capacity and capability, and a lack of coordination on screening and referral activities. Misalignment between clinical and CBO understanding of demand, needs and capacity present a potential risk in building strategies that integrate health and social services to address unmet social need. Failing to build a strong cross-sector screening and referral infrastructure that considers CBO capacity from the start could undermine the goal of improving population health through the integration of clinical and social care.

What do you mean by engagement? - evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations - scoping review

BACKGROUND

Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs.

OBJECTIVE

The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease.

METHODS

A scoping review guided by the methods outlined by Arksey and O'Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings.

RESULTS

We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review.

CONCLUSION

Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.

Capacity Development and Evaluation of a Parent Advisory Team Engaged in Childhood Obesity Research

Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members' perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature.

Assessing cancer center researcher and provider perspectives on patient engagement

Participatory research approaches can help ensure research is culturally relevant and aligned with stakeholder priorities, but barriers exist between researchers and community stakeholders, particularly in communities of color. We developed a measurement tool for assessing oncology researcher and provider readiness to undertake patient-engaged research, and piloted this measurement tool among oncology researchers and providers at the hospital's cancer care center. A survey was developed by drawing from existing PCORI assessments as well as creating original questions, in an effort to develop an evidence-based survey tailored to this project. A total of 23 researchers and providers responded to the survey. The majority of respondents indicated that they were moderately or very familiar with the concept of patient-centered outcomes research. Most respondents had little to no experience engaging in participatory research and endorsed several barriers to engaging patients in the research process, including lack of experience and time. A mechanism for preparing and supporting researchers and providers is needed if cancer centers are to implement patient-powered research agendas as recommended by PCORI.

Grounded in Culture: Reflections on Sitting Outside the Circle in Community-Based Research With Indigenous Men

Research continues to be a dirty word for many Indigenous people. Community-based participatory research (CBPR) is a means to disrupt power dynamics by engaging community members within the research process. However, the majority of relationships between researcher and participants within CBPR are structured within Western research paradigms and they often reproduce imbalances of power. The purpose of this article is to reflect on the process of CBPR within a research project focused on Indigenous men's masculinity and mental health. In doing so, we aim to contribute to reflexive practice in CBPR and flatten research hierarchies to facilitate more equitable knowledge sharing. Our reflections highlight the importance of prioritizing healing, centering cultural protocols, negotiating language, and creating space for Indigenous research partners to lead. These critical lessons challenge Western researchers to ground their practices in Indigenous culture while they "sit outside the circle" to facilitate more equitable and engaged partnerships.

Two communities, one highway and the fight for clean air: the role of political history in shaping community engagement and environmental health research translation

BACKGROUND

This paper explores strategies to engage community stakeholders in efforts to address the effects of traffic-related air pollution (TRAP). Communities of color and low-income communities are disproportionately impacted by environmental threats including emissions generated by major roadways.

METHODS

Qualitative instrumental case study design was employed to examine how community-level factors in two Massachusetts communities, the City of Somerville and Boston's Chinatown neighborhood, influence the translation of research into practice to address TRAP exposure. Guided by the Interactive Systems Framework (ISF), we drew on three data sources: key informant interviews, observations and document reviews. Thematic analysis was used.

RESULTS

Findings indicate political history plays a significant role in shaping community action. In Somerville, community organizers worked with city and state officials, and embraced community development strategies to engage residents. In contrast, Chinatown community activists focused on immediate resident concerns including housing and resident displacement resulting in more opposition to local municipal leadership.

CONCLUSIONS

The ISF was helpful in informing the team's thinking related to systems and structures needed to translate research to practice. However, although municipal stakeholders are increasingly sympathetic to and aware of the health impacts of TRAP, there was not a local legislative or regulatory precedent on how to move some of the proposed TRAP-related policies into practice. As such, we found that pairing the ISF with a community organizing framework may serve as a useful approach for examining the dynamic relationship between science, community engagement and environmental research translation. Social workers and public health professionals can advance TRAP exposure mitigation by exploring the political and social context of communities and working to bridge research and community action.

Mixed-method evaluation of a community-based postpartum support program: a study protocol

INTRODUCTION

Becoming a parent is one of the most significant events an individual will experience in their lifetime. The postpartum period can be a difficult time, especially for mothers, who may require extra support during this challenging time. The proposed study seeks to understand the issue of postpartum support for mothers and their families. It will address this aim by using the Mothercraft Ottawa Postpartum Support Drop-in Program as real-life illustration of a community-based service organisation delivering these services.

METHODS AND ANALYSIS

A three-phased mixed-method programme evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework and the tenets of community-based participatory research. Instrumental case study methodology will be employed to gain an in-depth understanding of what impact(s) the programme is having on mothers, their partners and their families (phase I-qualitative). A questionnaire, regression modelling, and geospatial analysis will be conducted to gain a deeper understanding of specific programme outputs and to generate information that will help inform programme reach (phase II-quantitative). Study phase III will focus on knowledge translation activities to stakeholders and the broader academic community.

ETHICS AND DISSEMINATION

Ethics approval was granted by the University of Ottawa Research Ethics Board (H-12-18-1492). The results of this study will be disseminated at a community workshop, in an academic thesis, at academic conferences and in peer-reviewed publications.

Tailored Approach to Sleep Health Education (TASHE): a randomized controlled trial of a web-based application

STUDY OBJECTIVES

In a randomized controlled trial, we compared the effect of the Tailored Approach to Sleep Health Education (TASHE) on obstructive sleep apnea (OSA) self-efficacy among community-dwelling blacks in New York City.

METHODS

Study participants were 194 blacks at high risk for OSA based on the Apnea Risk Evaluation System. TASHE intervention was delivered via a Wi-Fi-enabled tablet, programmed to provide online access to culturally and linguistically tailored information designed to address unique barriers to OSA care among blacks. Blacks in the attention-controlled arm received standard sleep information via the National Sleep Foundation website. Blacks in both arms accessed online sleep information for 2 months. Outcomes (OSA health literacy, self-efficacy, knowledge and beliefs, and sleep hygiene) were assessed at baseline, at 2 months, and at 6 months.

RESULTS

We compared outcomes in both arms based on intention-to-treat analysis using adjusted Generalized Linear Mixed Modeling. TASHE exposure significantly increased OSA self-efficacy (OSA outcome expectation [β = .5; 95% CI: .1-.9] and OSA treatment efficacy [β = 0.4; 95% CI: .0-.8]) at 2 months but not at 6 months. Additionally, TASHE exposure improved sleep hygiene at 6 months (β = 6.7; 95% CI: 2.2-11.3) but not at 2 months.

CONCLUSIONS

Community-dwelling blacks exposed to TASHE materials reported increased OSA self-efficacy compared with standard sleep health education. Stakeholder-engaged, theory-based approaches, as demonstrated in the TASHE intervention, can be used successfully to deliver effective sleep health messages.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; URL: https://clinicaltrials.gov/ct2/show/NCT02507089; Identifier: NCT02507089.

Designing a Participatory Total Worker Health® Organizational Intervention for Commercial Construction Subcontractors to Improve Worker Safety, Health, and Well-Being: The "ARM for Subs" Trial

Background: Evidence supports organizational interventions as being effective for improving worker safety, health and well-being; however, there is a paucity of evidence-based interventions for subcontracting companies in commercial construction. Methods: A theory-driven approach supplemented by formative research through key stakeholder interviews and focus groups and an iterative vetting process with stakeholders, resulted in the development of an intervention for subcontractors in the commercial construction industry. We piloted the intervention in one subcontracting commercial construction company. We used these findings to adapt and finalize the intervention design to be tested in a future large-scale trial. Results: There were several key findings from the formative research, including challenges faced by companies and assets that should be considered in the intervention design. This resulted in a communication infrastructure company-based, continual improvement, participatory intervention design, consisting of a needs assessment and report, committee-led prioritization, action planning and implementation, and worker communication/feedback cycle. The pilot contributed to the final intervention design with modifications made with respect to timing, implementation support, capacity building, adaptability and sustainability. Conclusions: The use of a theory-driven participatory approach to developing an integrated organizational intervention for commercial construction subcontracting companies was important and necessary. It allowed us to consider the empirical evidence and relevant theories and tailor these to meet the needs of our target population. This study gives pragmatic insight into the early development of a complex intervention, with practical experience of how we adapted our intervention at each stage. This intervention will be tested in a future randomized trial.

Benefits of Community-Based Approaches in Assessing and Addressing Sleep Health and Sleep-Related Cardiovascular Disease Risk: a Precision and Personalized Population Health Approach

PURPOSE OF REVIEW

In this current review, we describe the benefits of community-based and "precision and personalized population health" (P3H) approaches to assessing and addressing sleep health problems and sleep-related cardiovascular diseases (CVD) among vulnerable populations such as racial/ethnic minorities, the elderly, and the socioeconomically disadvantaged.

RECENT FINDINGS

Very few sleep health programs utilize a community-based or P3H approach, which may account for low estimates of sleep health problems, related CVD outcomes, and inadequate healthcare infrastructure to address sleep-related health outcomes at the community and population level. We describe community-based and P3H approaches and programs as solutions to accurately capture estimates of sleep health and reduce burden of sleep health problems and corollary CVD outcomes at the level of the community and population. Specifically, we describe seven critical steps needed to successfully implement a community-based and P3H approach to address sleep health problems. Community-based and P3H approaches are effective strategies to assessing and addressing sleep health problems and related health conditions.

Involving Urban Single Low-Income African American Mothers in Genomic Research: Giving Voice to How Place Matters in Health Disparities and Prevention Strategies

This article describes the process of using principles from community-based participatory action research to involve low-income, single, African American mothers on the south side of Chicago in genomic research, including as citizen scientists. The South Chicago Black Mothers' Resiliency Project used a mixed methods design to investigate how the stress of living in neighborhoods with high levels of violence affects mothers' mental and physical health. This article seeks to serve as a model for physicians and scholars interested in successfully involving low-income African American mothers in genomic research, and other health-related activities in ways that are culturally sensitive and transformative. The lives of Black mothers who struggle under interlocking systems of oppression that are often hidden from view of most Americans are at the center of this article. Therefore, we provide extensive information about the procedures used to collect the various types of data, the rationale for our procedures, the setting, the responses of mothers in our sample and methodological challenges. This study also has implications for the current COVID-19 pandemic and the need to train a corps of citizen scientists in health and wellness to avoid future extreme loss of life such as the 106,195 lives lost in the United States as of June 1, 2020.

CBPR Partnerships and Near-Roadway Pollution: A Promising Strategy to Influence the Translation of Research into Practice

Community-based participatory research (CBPR) aims to engage those traditionally left out of the research process. Partnering with community stakeholders to design, plan, implement and disseminate research can facilitate translation into practice. Using qualitative research methods, we set out to explore the policy and practice implications of a CBPR partnership focused on reducing exposure to near-roadway pollution. Key Informant interviews (n = 13) were conducted with individuals from various entities (municipal, state and private) for whom partners to the Community Assessment of Freeway Exposure and Health (CAFEH) provided technical assistance between 2013 and 2017. The findings indicate community research partnerships may have the power to inform local planning efforts. Developers and planners who the partnership consulted indicated a greater awareness of the implications of near-roadway exposure. They also described making changes in their practice based on study findings. The CAFEH partnership has demonstrated active attention to translating knowledge can influence local planning and practice, albeit with some challenges.

The HEAAL Project: Applying Community-Based Participatory Research (CBPR) Methodology in a Health and Mental Health Needs Assessment With an African Immigrant and Refugee Faith Community in Lowell, Massachusetts

Community-based participatory research methodology is driven by community interests and rooted in community involvement throughout the research process. This article describes the use of community-based participatory research methodology in the HEAAL project (Health and Mental Health Education and Awareness for Africans in Lowell), a research collaboration between Christ Jubilee International Ministries-a nondenominational Christian church in Lowell, Massachusetts, that serves an African immigrant and refugee congregation-and the Massachusetts General Hospital Department of Psychiatry. The objective of the HEAAL project was to better understand the nature, characteristics, scope, and magnitude of health and mental health issues in this faith community. The experience of using community-based participatory research in the HEAAL project has implications for research practice and policy as it ensured that research questions were relevant and meaningful to the community; facilitated successful recruitment and navigation through challenges; and can expedite the translation of data to practice and improved care.

Capacity Building in Community Stakeholder Groups for Increasing Physical Activity: Results of a Qualitative Study in Two German Communities

Community capacity building is an essential approach for health promotion, combining a participatory approach with the view to community ownership. Little research focuses on practical capacity building strategies and monitoring. Our paper looks into involving stakeholders in facilitated group discussions as a specific strategy for fostering capacity building processes. These processes focused on physical activity (PA) promotion in two German communities (ACTION4men). Along the dimensions of capacity building suggested in literature (e.g., problem solving, resource mobilization, leadership), we implemented two participatory stakeholder groups (1/community). These groups were motivated to develop and implement PA interventions for men >50 years. For measuring capacity building processes, a semi-standardized monitoring instrument was used to document all group meetings. Additionally, we conducted semi-standardized interviews with group participants and drop-outs to capture their perspectives on capacity building. All documents were analyzed using thematic analysis. We successfully established stakeholder groups that planned and implemented a range of local measures meant to increase PA among older men. In one community, the process was sustainable, whereby the group continued to meet regularly over years. Capacity building was successful to a certain degree (e.g., regarding participation, problem assessment, and resource mobilization), but stalled after first meetings. Capacity building processes differed between the two communities in terms of leadership and sustainability. The developed interventions mainly addressed the access to organized sport courses, rather than tackling walkability or active transport. The theoretical capacity building approach was successful to develop and implement programs aimed at promoting PA. The actual capacity building processes depend upon the composition of stakeholder groups and inherent power relations.

A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach

BACKGROUND

Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities.

OBJECTIVE

This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention.

METHODS

We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides.

RESULTS

We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities.

CONCLUSIONS

These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485.

How Health Promoters Can Assess Capacity Building Processes in Setting-Based Approaches-Development and Testing of a Monitoring Instrument

Background: Health promoters often use stakeholder groups to jointly plan and implement local interventions. Stakeholder groups should take over responsibility to later run the health promotion program independently. Monitoring this process of capacity building can help health promoters improve the quality of the process. Instruments for the systematic assessment of capacity building among stakeholder groups are scarce. The goal of this study was to develop, and pilot test a generic assessment instrument for setting-based capacity building. Methods: We drafted a semi-standardized monitoring instrument to be used in stakeholder groups in various settings. This "EVA-protocol" (short for evaluation protocol) was based on capacity building domains e.g., leadership, resource mobilization. It was pilot implemented in a research network on increasing an active lifestyle in various settings. The respective health promoters documented 78 meetings of 15 different stakeholder groups. We performed feedback interviews and member checking among the facilitating health promoters, asking for comprehensibility, length, usability and perceived benefits of the instrument. Findings: Data collected in the "EVA-protocol" helped the facilitating health promoters understand the development of competences and capacities in the stakeholder groups and identify factors that favor or hinder the capacity building process. The instrument was rated as user friendly, but it was remarked that it is best filled out by two persons and reflected upon by those to offer the greatest benefit. Not all projects could afford this procedure due to lack of time/staff resources. Conclusions: The drafted instrument can serve as quality management tool for health promoters who facilitate participatory stakeholder groups in different settings and intend to build capacities for sustainable health promotion structures.

Community stakeholder engagement during a vaccine demonstration project in Nigeria: lessons on implementation of the good participatory practice guidelines

Introduction

To report on the successes and challenges with implementing the good participatory practice guidelines for the Nigerian Canadian Collaboration on AIDS Vaccine (NICCAV) project.

Methods

An open and close ended questionnaire was administered to 25 randomly selected community stakeholders on the project. The questions sought information on perception about the community entry, constitution and function of the community advisory board (CAB) and community based organization (CBO), media engagement process, and research literacy programmes. The quantitative and qualitative data were analysed and findings triangulated.

Results

The project exceeded its targets on CBO engagement and community members reached. Stakeholders had significant improvement in knowledge about HIV vaccine research design and implementation (p=0.004). All respondents felt satisfied with the community entry, CAB constitution process, function and level of media engagement; 40% were satisfied with the financial support provided; 70% felt the community awareness and education coverage was satisfactory; and 40% raised concerns about the study site selection with implications for study participants' recruitment.

Conclusion

The NICCAV community stakeholder engagement model produced satisfactory outcomes for both researchers and community stakeholders. The inclusion of an advocacy and monitoring plan enabled it to identify important challenges that were of ethical concerns for the study.

The RxHL study: community-responsive research to explore barriers to medication adherence

This study aims to contribute to the development of community-responsive research approaches by describing the research methods used in the RxHL study and the interprofessional and community-based collaboration that produced them. The mixed-method RxHL study was developed in close consultation with staff and providers at our research site, a federally qualified health center in Springfield, MA. We utilized quantitative methods including chart review, manual pill counts and self-report surveys to assess factors associated with medication adherence in a diverse population of low-income patients with chronic disease. We triangulated these results with findings from qualitative methods that included in-depth interviews, home visits and chronic disease diaries. We used the constant comparison method and interdisciplinary, participatory team meetings to integrate quantitative and qualitative findings. A community-responsive approach facilitated the recruitment and retention of a diverse sample of patients. Self-report surveys revealed the widespread scope of barriers to care such as medication costs and transportation, and limited health literacy among diverse groups. Qualitative research methods offered a deeper understanding of the social and environmental contexts in which medication adherence takes place. Prioritizing the needs of community partners and research participants facilitates rigorous data collection in clinical settings with maximum participation from community partners.

Development and Evaluation of a Blood Glucose Monitoring YouTube Video for Marshallese Patients Using a Community-Based Participatory Research Approach

The purpose of this study was to (a) describe the development of a culturally appropriate glucose monitoring video using a community-based participatory research approach and (b) assess the cultural appropriateness and effectiveness of the video. The topic of the video-using a glucometer and the importance of performing blood glucose checks-was chosen by Marshallese community stakeholders. The video was produced in Marshallese with English subtitles and disseminated through YouTube. Participants were recruited from August 16, 2016 to September 12, 2016 in a diabetes clinic that serves Marshallese patients in northwest Arkansas. Fifty participants completed a survey at pre- and postintervention, with questions capturing demographic information and questions on glucose monitoring self-efficacy using an adapted version of the Stanford Patient Education Research Center's Diabetes Self-Efficacy Scale. Twenty of those participants who completed the survey also completed semistructured interviews that assessed cultural appropriateness and effectiveness of the video. Participants reported significant increases in self-efficacy related to glucometer use and the importance of performing blood glucose checks (p < .001) and a 1.45% reduction in A1C between preintervention and 12 weeks postintervention (p = .006). Qualitative results indicated the video was both culturally appropriate and effective. The findings of this study were consistent with evidence in the literature, which shows health education videos can be effective at improving health behaviors. Using a community-based participatory research approach to prioritize video topics, and including members of the community in the creation and dissemination of the videos, could aid in ensuring the videos are effective and culturally appropriate.

Strategies to Facilitate Equitable Resource Sharing in Community-Engaged Research

BACKGROUND

Community subcontracts are an essential component of community-engaged research, particularly community-based participatory research (CBPR). However, several barriers have limited community-based organizations' (CBOs) ability to serve as subcontractors on research grants. This article describes the barriers and strategies to implementing community subcontracts through a case study of the implementation of one federal grant.

LESSONS LEARNED

Specific lessons learned at the CBO level, budget-creation level, and university-level are described to overcome barriers in executing community subcontracts in community-engaged research.

CONCLUSIONS

We call for institutional changes to facilitate equitable resource sharing in community-engaged research.

Advancing Nutrition in the International Food Assistance Agenda: Progress and Future Directions Identified at the 2018 Food Assistance for Nutrition Evidence Summit

BACKGROUND

Global food insecurity persists despite continued international attention, necessitating evidence-based food assistance interventions that adequately address nutritional concerns. In June 2018, the US Agency for International Development's Office of Food for Peace through the Food Aid Quality Review (FAQR) project sponsored a "Food Assistance for Nutrition Evidence Summit" to share evidence relevant to policy and programmatic decision-making and to identify critical evidence gaps.

OBJECTIVE

This article presents 4 priority areas to advance nutrition in the international food assistance agenda generated through presentations and discussions with the food assistance community at the Evidence Summit.

METHODS

Priority areas were identified after the Evidence Summit using a combination of FAQR team discussions, review of presentations and official notes, and supporting literature.

RESULTS

Key priority areas to advance nutrition in the international food assistance agenda are as follows: (1) increase research funding for food assistance in all contexts, paying particular attention to emergency settings; (2) research and adopt innovative ingredients, technology, and delivery strategies in food assistance products and programs that encourage long-term well-being; (3) redefine and expand indicators of nutritional status to capture contextual information about the outcomes of food assistance interventions; and (4) augment communication and collaboration across the food assistance ecosystem.

CONCLUSIONS

These priorities are critical in a time of increased humanitarian need and will be key to fostering long-term resilience among vulnerable groups.

How Alcohol, Space, and Time Influence Young People's Sexual Encounters in Tanzania: A Qualitative Analysis

A significant under-addressed issue in the global adolescent health agenda is the interaction between alcohol use and sexual encounters among adolescent boys and girls in sub-Saharan Africa. The aim of this study was to explore the structural and environmental factors influencing young people's access to and use of alcohol, and subsequent engagement in safe or unsafe sexual behaviors in such contexts, from the perspective of young people themselves. We used qualitative and participatory methodologies to explore the experiences and perspectives of 177 adolescent girls and boys in and out of school in four sites across Dar es Salaam, Tanzania. Findings suggest that alcohol use intersects with a spatial dimension in relation to where youths are consuming alcohol and subsequently engaging in sex. This in turn influences young people's likelihood of using condoms and practicing safer sex. The spatial dimension was found to be influenced by time, gender, age, economics, and social norms around the carrying of and use of condoms. Interventions are needed that both address the gendered and social sanctioning of youth carrying condoms in Tanzania and that increase the availability of condoms where alcohol is sold and consumed.

Ancillary Benefit of Increased HPV Immunization Rates Following a CBPR Approach to Address Immunization Disparities in Younger Siblings

Increasing HPV vaccination rates may decrease the disproportionately high HPV-associated disease incidence and mortality in African Americans (AA) and lower socioeconomic individuals. Data from a community-based participatory research (CBPR) study addressing immunization disparities among 19-35 month old children was analyzed to identify ancillary benefits in HPV immunization rates for adolescent siblings. Sub-study analysis inclusion criteria: AA (N = 118), 13-17 years old, younger sibling enrolled in parent study, and enrolled ≥ 9 months. Parent/caregiver interventions included: a web-based immunization toolkit with information on age-appropriate vaccines; a multimedia community outreach campaign; and reminder mailings. HPV up-to-date (UTD) status was defined as Wisconsin Immunization Registry (WIR) documentation of at least three HPV vaccines. McNemar's test compared pre/post intervention HPV status. Two dependent proportions testing compared the proportion of adolescents that became UTD in the study cohort, City of Milwaukee, and State of Wisconsin. Parents/caregivers perceived that 92% of adolescents were HPV-UTD, while only 24% had a WIR-verified HPV-UTD status. Baseline UTD status of the younger siblings 19-35 month old 4:3:1:3:3:1:4 antigen series was 63%, which increased to 86% at study completion. Adolescent's HPV-UTD immunization status increased from 30 (25%) at enrollment to 54 (46%) at study completion [p = 0.004]. A statistically significant larger proportion of adolescents became HPV-UTD in the study cohort (20%) compared to the City of Milwaukee [14%, p = 0.042] and the State of Wisconsin [14%, p = 0.046]. A culturally-tailored CBPR approach targeting parents/caregivers of younger AA children can have significant ancillary benefit to increase HPV immunization rates in adolescent siblings.

Developing a culturally tailored multigenerational intervention to prevent and manage type 2 diabetes in American Indian families living in rural settings: Findings from a focus group study

The study purpose was to understand the characteristics of interventions that would be most relevant and beneficial to address the diabetes-related needs and challenges of rural American Indians/Alaska Natives (AIAN) with type 2 diabetes (T2D) and their families. In an exploratory study design, we held a total of seven focus groups in Florida and rural Oklahoma. Groups included 3-13 individuals (62 total, 77% were female, mean age 55.3 [11.4] years and mean duration of diabetes 10.4 [SD 9.1] years) who were referred by staff from HealthStreet, Consent2Share mechanism, and by tribal educators. All groups were moderated by the same American Indian research team member using a discussion guide with open-ended questions, followed by probes. Findings revealed themes centered on optimal intervention components, barriers to type 2 diabetes-prevention and management (T2D-PM), personal experiences with T2D, and impact of family behaviors on T2D-PM. Findings indicate that the participants desire diabetes programs that include family members and a hands-on, culturally meaningful approach. Creating an intervention based on the AIAN community's insights that include the entire family may improve T2D-PM outcomes for this population.

Perspectives on diet and physical activity among urban African Americans with serious mental illness

African Americans are burdened by high rates of obesity that contribute to chronic disease and early mortality. To tailor a weight loss intervention to meet the needs of African Americans with serious mental illness, a community-based participatory research (CBPR) team comprised primarily of African Americans with serious mental illness guided qualitative research to understand factors that affect weight and interventions that may diminish obesity. Data from five focus groups (n = 55) were analyzed to better understand this group's needs. Participants voiced individual, social, and structural barriers to maintaining and achieving a healthy weight and provided perspectives on potential solutions.

The Community Faces Model: Community, University and Health Department Partners Thriving Together for Effective Health Education

We use a community based participatory research approach to examine the processes of collaboration and communication, as well as the relational interactions of one community focused health promotion coalition, the Community Faces of Utah (CFU). We assess the evolution, structure, successes, and challenges of the coalition, comprised of five distinct cultural communities, a state health department, and a university. Researchers from the university collaborated with the coalition to find that CFU is an equitable, collaborative partnership of diverse leaders that functions successfully. Shared values and trusting relationships emerged over time, forming the basis for group interaction. A community liaison to facilitate interaction and collaboration was an essential element of the success of this partnership. The experience of CFU can guide other multi-sectoral partnerships in developing functionality consistent with achieving community driven objectives.

How stakeholder engagement influenced a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions in a Marshallese Pacific Islander Community

BACKGROUND

Marshallese face significant health disparities, with particularly high rates of type 2 diabetes. Engaging stakeholders in the research process is essential to reduce health inequities.

METHODS

A community- and patient-engaged research approach was used to involve community Marshallese stakeholders in a randomized comparative effectiveness trial testing two Diabetes Prevention Program interventions.

RESULTS

The article outlines the engagement process and the specific influence that stakeholders had on the research planning and implementation, discussing the areas of agreement and disagreement between community and patient stakeholders and academic investigators and documenting changes to the research protocol.

CONCLUSION

The article provides an example of methods that can be used to design and conduct a randomized controlled trial testing with a population who has been underrepresented in research and suffered significant historical trauma.

System Failure: Work Organization and Injury Outcomes among Latino Forest Workers

OBJECTIVES

Forestry services is a hazardous industry with high job-related injury, illness, and fatality rates. The Northwest workforce is largely Spanish-speaking, Latino, and immigrant, working in poor conditions with insufficient attention paid to safety and health. Institutional racism fundamentally shapes the structural vulnerability of Latino immigrant workers. Given this context, we sought to understand how workplace organizational factors and safety climate affect job-related injuries in this industry.

METHODS

We developed 23 case studies from personal interviews after selecting from an initial participant survey pool of 99 Latino forest workers in southern Oregon who had been injured at work in the previous 2 years. Workers were recruited through snowball sampling and door-to-door canvassing. Questions spanned work conditions, tasks, employer safety practices, injury experience, medical treatment, and workers' compensation benefits.

RESULTS

Workers reported broken bones, chainsaw lacerations, back pain, heat and pesticide illnesses, and other occupational injuries. One-third of the cases fell into a Systems Functional category in which they reported their injuries to their supervisors and received medical treatment and workers' compensation benefits. The remaining two-thirds experienced System Failures with difficulties in receiving medical treatment and/or workers' compensation benefits, employer direction to not report, being fired, or seeking alternative home remedies.

CONCLUSION

Workers employed by companies with more indicators of safety climate were more likely to obtain adequate treatment for their injuries and fully recover. Workers for whom interpretation at medical exams was provided by someone unaffiliated with their employers also reported better treatment and recovery outcomes.

Designing and Facilitating Collaborative Research Design and Data Analysis Workshops: Lessons Learned in the Healthy Neighborhoods Study

One impediment to expanding the prevalence and quality of community-engaged research is a shortage of instructive resources for collaboratively designing research instruments and analyzing data with community members. This article describes how a consortium of community residents, grassroots community organizations, and academic and public institutions implemented collaborative research design and data analysis processes as part of a participatory action research (PAR) study investigating the relationship between neighborhoods and health in the greater Boston area. We report how nine different groups of community residents were engaged in developing a multi-dimensional survey instrument, generating and testing hypotheses, and interpreting descriptive statistics and preliminary findings. We conclude by reflecting on the importance of balancing planned strategies for building and sustaining resident engagement with improvisational facilitation that is responsive to residents’ characteristics, interests and needs in the design and execution of collaborative research design and data analysis processes.

Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand

BACKGROUND

Research adhering to community engagement processes leads to improved outcomes. The level of Indigenous communities' engagement in rheumatology research is unknown.

OBJECTIVE

To characterize the frequency and level of community engagement reporting in arthritis studies conducted in Australia (AUS), Canada (CAN), New Zealand (NZ) and the United States of America (USA).

METHODS

Studies identified through systematic reviews on topics of arthritis epidemiology, disease phenotypes and outcomes, health service utilization and mortality in Indigenous populations of AUS, CAN, NZ and USA, were evaluated for their descriptions of community engagement. The level of community engagement during inception, data collection and results interpretation/dissemination stages of research was evaluated using a custom-made instrument, which ranked studies along the community engagement spectrum (i.e. inform-consult-involve-collaborate-empower). Meaningful community engagement was defined as involving, collaborating or empowering communities. Descriptive analyses for community engagement were performed and secondary non-parametric inferential analyses were conducted to evaluate the possible associations between year of publication, origin of the research idea, publication type and region of study; and meaningful community engagement.

RESULTS

Only 34% (n = 69) of the 205 studies identified reported community engagement at ≥ 1 stage of research. Nearly all studies that engaged communities (99% (n = 68)) did so during data collection, while only 10% (n = 7) did so at the inception of research and 16% (n = 11) described community engagement at the results' interpretation/dissemination stage. Most studies provided community engagement descriptions that were assessed to be at the lower end of the spectrum. At the inception of research stage, 3 studies reported consulting communities, while 42 studies reported community consultation at data collection stage and 4 studies reported informing or consulting communities at the interpretation/dissemination of results stage. Only 4 studies described meaningful community engagement through all stages of the research. Inferential statistics identified that studies with research ideas that originated from the Indigenous communities involved were significantly more associated with achieving meaningful community engagement.

CONCLUSIONS

The reporting of Indigenous community engagement in published arthritis studies is limited in frequency and is most frequently described at the lower end of the community engagement spectrum. Processes that support meaningful community engagement are to be promoted.

Best Practices for Community-Engaged Research with Pacific Islander Communities in the US and USAPI: A Scoping Review

This scoping review identifies the best practices of community-based participatory research with Pacific Islanders in the United States and United States Affiliated Pacific Islands. Eighty-four articles from January 2000 to December 2017 were included in the review. Best practices included the importance of engaging Pacific Islander community leaders as research staff, community co-investigators, and community advisory board members. Best practices also focused on removing barriers to research by using participants' native languages, conducting research within the geographic community, and spending significant time to build trust. Novel best practices included honoring Pacific Islanders' cultural practices such as protocols for engagement, reciprocity, and social and spiritual inclusiveness and honoring Pacific Islanders' collectivist cultural structure. The goal of this scoping review is to aid community-academic partnerships working to improve the health of Pacific Islanders.

Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project

BACKGROUND

Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women.

PURPOSE

To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma.

METHODS

A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach.

RESULTS

Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.

The cascade of social determinants in producing chronic disease in low-income African-American men

PURPOSE

There is a dearth of effective, evidence-based programs to reduce chronic disease in low-income African-American men. We report on the results of formative research in the National Institutes of Health (NIH)-funded MOCHA Moving Forward project on factors identified by the participants to drive health disparities.

METHODS

Based on individual interviews with 42 middle-aged (40-65 years), low-income African-American men, three themes emerged.

RESULTS

First, the results indicate a hierarchy in the perceived relative influence of different factors, with poverty and unemployment perceived to have the most powerful affects. Second, results show that factors in different domains do not operate as discrete independent influences, but rather, interact synergistically. Finally, the findings show how perceived social structural constraints have produced deep cynicism about the future, with notably divergent reactions, producing a sense that there is almost nothing an individual can do, or paradoxically, a greater the sense of personal responsibility.

CONCLUSION

The implications of addressing the cascade of social determinants to reduce chronic disease in African-American men are discussed.

Using Ripple Effects Mapping to Evaluate a Community-Based Health Program: Perspectives of Program Implementers

Traditional evaluation tools are oftentimes ill-suited for use in community settings where intervention outcomes of interest may occur at multiple levels and are influenced by interacting factors. Ripple effects mapping (REM) is a participatory technique engaging stakeholders to visually map project/program efforts and results to collect impact data. Using appreciative inquiry, the method helps participants and evaluators understand context for changes resulting from program experiences and is particularly well suited for community-based, participatory programs where impacts often occur beyond the individual level. This article describes the REM method and how it was applied to explore impact and refine program theory of the Extension Wellness Ambassador Program (EWAP), a community-based health-focused master volunteer program, from the perspective of program implementers ( n = 10). Insights emerging from the REM session indicate EWAP promotes health behavior change, contributes to community development due to increased leadership capacity, and sustains and grows implementing organizations. The program theory shaping evaluation was refined to better capture impact beyond individual levels. Application of the REM method to a community health program demonstrates feasibility; health promotion practitioners should consider REM to understand program context and capture outcomes that typically evade measurement using traditional techniques.

Dark clouds in co-creation, and their silver linings practical challenges we faced in a participatory project in a resource-constrained community in India, and how we overcame (some of) them

Background: While any type of field-based research is challenging, building action-oriented, participatory research in resource-constrained settings can be even more so.

Objective: In this article, we aim to examine and provide insights into some of the practical challenges that were faced during the course of a participatory project based in two non-notified slums in Bangalore, India, aiming to build solutions to indoor air pollution from cooking on traditional cook stoves.

Methods: The article draws upon experiences of the authors as field researchers engaged in a community-based project that adopted an exploratory, iterative design to its planning and implementation, which involved community visits, semi-structured interviews, prioritization workshops, community forums, photo voice activities, chulha-building sessions and cooking trials.

Results: The main obstacles to field work were linked to fostering open, continued dialogue with the community, aimed at bridging the gap between the ‘scientific’ and the ‘local’ worlds. Language and cultural barriers led to a reliance on interpreters, which affected both the quality of the interaction as well as the relationship between the researchers and the community that was built out of that interaction. The transience in housing and location of members of the community also led to difficulties in following up on incomplete information. Furthermore, facilitating meaningful participation from the people within the context of restricted resources, differing priorities, and socio-cultural diversity was particularly challenging. These were further compounded by the constraints of time and finances brought on by the embeddedness of the project within institutional frameworks and conventional research requirements of a fixed, pre-planned and externally determined focus, timeline, activities and benchmarks for the project.

Conclusions: This article calls for revisiting of scientific conventions and funding prerequisites, in order to create spaces that support flexible, emergent and adaptive field-based research projects which can respond effectively to the needs and priorities of the community.

Impact and Lessons Learned from a National Consortium for Participatory Health Research: PartKommPlus-German Research Consortium for Healthy Communities (2015-2018)

Integrated strategies of health promotion at the municipal level are receiving particular attention in public health policy and practice in Germany. These strategies are intended to provide a coordinated approach to health promotion during the entire lifespan, with a particular focus on vulnerable communities. They are also intended to be participatory in both their design and implementation, involving all sectors of the social welfare, educational and healthcare systems, civil society, and the general public. PartKommPlus-German Research Consortium for Healthy Communities is examining such strategies using participatory forms of research. The goal is to determine how participation can best be planned and implemented and what effects this participation has. In this article the work of PartKommPlus from the first funding phase (2015-2018) will be described with particular attention to the lessons learned and the forms of impact which are being considered as part of the participatory research process.

Developing FAITHH: Methods to Develop a Faith-Based HIV Stigma-Reduction Intervention in the Rural South

Human immunodeficiency virus (HIV) disproportionately affects Blacks/African Americans, particularly those residing in the southern United States. HIV-related stigma adversely affects strategies to successfully engage people in HIV education, prevention, and care. Interventions targeting stigma reduction are vital as additional tools to move toward improved outcomes with HIV prevention and care, consistent with national goals. Faith institutions in the South have been understudied as partners in HIV stigma-reduction efforts, and some at-risk, Black/African American communities are involved with southern faith institutions. We describe the collaborative effort with rural, southern faith leaders from various denominations to develop and pilot test Project Faith-based Anti-stigma Initiative Towards Healing HIV/AIDS (FAITHH), an HIV stigma-reduction intervention that built on strategies previously used with other nonrural, Black/African American faith communities. The eight-module intervention included educational materials, myth-busting exercises to increase accurate HIV knowledge, role-playing, activities to confront stigma, and opportunities to develop and practice delivering a sermon about HIV that included scripture-based content and guidance. Engaging faith leaders facilitated the successful tailoring of the intervention, and congregation members were willing participants in the research process in support of increased HIV awareness, prevention, and care.

Healthcare barriers and supports for American Indian women with cancer

Although American Indian (AI) women continue to experience cancer at higher rates and have not seen the same decline in cancer prevalence as the general U.S. population, little research examines how interactions with health care providers may influence and exacerbate these health disparities. The purpose of the study was to understand the experiences of AI women who receive cancer treatment, which is integral for eradication of AI cancer disparities among women. A qualitative descriptive methodology was used with a sample of 43 AI women with breast, cervical, colon, and other types of cancer from the Northern Plains region of South Dakota. Interviews were conducted from June 2014 to February 2015. Qualitative content analysis revealed that women experienced: (a) health concerns being ignored or overlooked; (b) lack of consistent and qualified providers; (c) inadequate healthcare infrastructure; (d) sub-optimal patient-healthcare provider relationships; (e) positive experiences with healthcare providers; and (f) pressure and misinformation about treatment. Results indicate the types of support AI women may need when accessing healthcare. Culturally informed trainings for healthcare professionals may be needed to provide high-quality and sensitive care for AI women who have cancer, and to support those providers already providing proper care.