Community-based participatory research: implications for public health funding

Perceived Barriers to Managing Medications and Solutions to Barriers Suggested by Bhutanese Former Refugees and Service Providers

Introduction: The purpose of this study was to explore perceived barriers to managing medications and potential solutions to such barriers among Bhutanese former refugees and service providers in Tasmania, Australia. Method: Thirty Bhutanese former refugees and service providers recruited through community health programs participated in a community-based participatory research design. Data were elicited through a structured focus group process and analyzed using content analysis. Results: Perceived barriers to managing medications included language barriers, low health literacy, and culturally unresponsive interactions with services. Themes identifying potential solutions to barriers referred to the functional health literacy of individuals (providing reassurance, checking understanding, and involving support networks) and creating supportive health care environments (consistent service providers, culturally responsive care, assistance navigating services, using trained interpreters). Discussion: Creating environments conducive to interactive and critical health literacy about medications is as important for culturally congruent care as supporting the functional health literacy of individuals.

Participatory action research (PAR) research: critical methodological considerations

Purpose

The purpose of this paper is to explore a range of key deliberations with regards to adopting participatory action research (PAR) and privileged access interviewer (PAI) approaches and methodologies within research on substance use.

Design/methodology/approach

This paper is a reflective piece; it adopts a mixture of applied practice and theory considerations. These conceptualisations capture what are still relatively early understandings and uses of such methodologies, acquired across several decades of research and service provision experiences. The paper is structured around some of the sequences of the research process and as such provides a broad framework for such approaches.

Findings

PAR and PAI approaches utilise several key theoretical considerations. There are many critical issues associated with adopting these approaches, including those of ethics, funding, involvement, language, resources and support. Three key principle reasons (moral, political and research based) help explain why the authors should see more adoption of such approaches in substance use-related research.

Research limitations/implications

This paper represents authors’ views which are by their nature very subjective.

Practical implications

Implementation of the key considerations highlighted within this paper can lead to an active adoption of PAR and PAI methodologies within alcohol and drug research. Increasing the use of such methodologies will allow commissioners, researchers and service providers to develop a more nuanced understanding of the experiences of and responses to alcohol and drug use.

Originality/value

This paper captures critical conversations at a time of increased calls for service user involvement across all aspects of alcohol and other drug provision, including evaluation and research

"One program that could improve health in this neighbourhood is ____?" using concept mapping to engage communities as part of a health and human services needs assessment

BACKGROUND

This paper presents the findings of a rapid needs assessment conducted at the request of the local health authority responsible for health care services, the Toronto Central Local Health Integration Network (Ontario, Canada), to inform health and social service planning.

METHODS

We utilized concept mapping methodology to facilitate engagement with diverse stakeholders-more than 300 community members and service providers-with a focus on hard to reach populations. Key informant interviews with service providers were used to augment findings.

RESULTS

Participants identified 48 unique services or service approaches they believed would improve the health of residents in the area, including those addressing health care, mental health and addictions, youth, families, people experiencing homelessness, seniors, general social services, and services targeting specific populations. While service providers consistently identified a critical need for mental health and addiction services, community members placed greater importance on the social determinants of health including access to housing, job placement supports and training and service accessibility. Both groups agreed that services and programs for seniors and people experiencing homelessness would be highly important.

CONCLUSION

Our study provides a unique example of using concept mapping as a tool to aid a rapid service gap analysis and community engagement in a metropolitan area. The findings also reinforce the importance of working cross-sectorally, using a Health in All Policies approach when planning services for underserved populations.

Community-based participatory research and integrated knowledge translation: advancing the co-creation of knowledge

BACKGROUND

Better use of research evidence (one form of "knowledge") in health systems requires partnerships between researchers and those who contend with the real-world needs and constraints of health systems. Community-based participatory research (CBPR) and integrated knowledge translation (IKT) are research approaches that emphasize the importance of creating partnerships between researchers and the people for whom the research is ultimately meant to be of use ("knowledge users"). There exist poor understandings of the ways in which these approaches converge and diverge. Better understanding of the similarities and differences between CBPR and IKT will enable researchers to use these approaches appropriately and to leverage best practices and knowledge from each. The co-creation of knowledge conveys promise of significant social impacts, and further understandings of how to engage and involve knowledge users in research are needed.

MAIN TEXT

We examine the histories and traditions of CBPR and IKT, as well as their points of convergence and divergence. We critically evaluate the ways in which both have the potential to contribute to the development and integration of knowledge in health systems. As distinct research traditions, the underlying drivers and rationale for CBPR and IKT have similarities and differences across the areas of motivation, social location, and ethics; nevertheless, the practices of CBPR and IKT converge upon a common aim: the co-creation of knowledge that is the result of knowledge user and researcher expertise. We argue that while CBPR and IKT both have the potential to contribute evidence to implementation science and practices for collaborative research, clarity for the purpose of the research-social change or application-is a critical feature in the selection of an appropriate collaborative approach to build knowledge.

CONCLUSION

CBPR and IKT bring distinct strengths to a common aim: to foster democratic processes in the co-creation of knowledge. As research approaches, they create opportunities to challenge assumptions about for whom, how, and what is defined as knowledge, and to develop and integrate research findings into health systems. When used appropriately, CBPR and IKT both have the potential to contribute to and advance implementation science about the conduct of collaborative health systems research.

Development of the Social Network-Based Intervention "Powerful Together with Diabetes" Using Intervention Mapping

This article describes the development of the social network-based intervention Powerful Together with Diabetes which aims to improve diabetes self-management (DSM) among patients with type 2 diabetes living in socioeconomically deprived neighborhoods by stimulating social support for DSM and diminishing social influences hindering DSM (e.g., peer pressure and social norms). The intervention was specifically developed for patients with Dutch, Turkish, Moroccan, and Surinamese backgrounds. The intervention was developed according to Intervention Mapping. This article describes the first four steps of Intervention Mapping: (1) the needs assessment; (2) development of performance and change objectives; (3) selection of theory-based methods and strategies; and (4) the translation of these into an organized program. These four steps resulted in Powerful Together with Diabetes, a 10-month group-based intervention consisting of 24 meetings, 6 meetings for significant others, and 2 meetings for participants and their spouses. The IM method resulted in a tailored approach with a specific focus on the social networks of its participants. This article concludes that the IM method helped our planning team to tailor the intervention to the needs of our target population and facilitated our evaluation design. However, in hindsight, the intervention could have been improved by investing more in participatory planning and community involvement.

Series: Practical guidance to qualitative research. Part 2: Context, research questions and designs

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. This second article addresses FAQs about context, research questions and designs. Qualitative research takes into account the natural contexts in which individuals or groups function to provide an in-depth understanding of real-world problems. The research questions are generally broad and open to unexpected findings. The choice of a qualitative design primarily depends on the nature of the research problem, the research question(s) and the scientific knowledge one seeks. Ethnography, phenomenology and grounded theory are considered to represent the 'big three' qualitative approaches. Theory guides the researcher through the research process by providing a 'lens' to look at the phenomenon under study. Since qualitative researchers and the participants of their studies interact in a social process, researchers influence the research process. The first article described the key features of qualitative research, the third article will focus on sampling, data collection and analysis, while the last article focuses on trustworthiness and publishing.

Developing Research Collaborations in an Academic Clinical Setting: Challenges and Lessons Learned

Research collaboration in "real world" practice settings may enhance the meaningfulness of the findings and reduce barriers to implementation of novel intervention strategies. This study describes an initiative to integrate research into a hospital-based outpatient psychiatric clinic within an academic medical center, focusing on collaborative processes across three research projects. We report on the varied outcomes of the projects and utilize data from two focus groups to identify the key elements that contributed to the challenges and successes. We identify barriers to practice-research collaborations that emerged even when the initial circumstances of the partnership were favorable. These barriers include the presence of varied agendas across clinicians and investigators, resource constraints, limited staff buy-in, and staff turnover. In highlighting the lessons learned in this collaborative process, we hope to facilitate successful partnerships in other clinical settings.

Patient engagement in patient-centered outcomes research: challenges, facilitators and actions to strengthen the field

AIM

To describe challenges to and facilitators of patient engagement to inform future strategies and suggested actions to strengthen engagement.

METHODS

Interviews with 19 principal investigators of projects funded by the Patient-Centered Outcomes Research Institute and with 33 patients from 18 of the 19 projects.

RESULTS

Facilitators included using existing resources, having clear goals, educating patients and treating patients respectfully. Logistical challenges included extra time and work, institutional barriers and difficulty having meetings. Substantive challenges to selecting, educating and engaging patients, and incorporating feedback were also reported.

CONCLUSION

To bolster the infrastructure for engagement, we suggest funders, institutions and researchers focus on resources and training for researchers and patients, networks and programs to connect stakeholders and model policies.

Coproduction of Research Questions and Research Evidence in Public Health: The Study to Prevent Teen Drinking Parties

Community-based participatory research (CBPR) provides a set of principles and practices intended to foster coproduction of knowledge. However, CBPR often has shortcomings when applied to population-level policy and practice interventions, including a focus on single communities and a lack of focus on policy change. At the same time, community trials focused on policy have shortcomings, including lack of stakeholder involvement in framing research questions and modest engagement in study implementation and interpretation and dissemination of results. We describe an attempt to hybridize CBPR and community trials by creating a partnership that included a national membership organization, a coalition advisory board, intervention and delayed intervention communities, and an academic study team, which collaborated on a study of community strategies to prevent underage drinking parties. We use qualitative and quantitative data to critically assess the partnership. Areas where the partnership was effective included (1) identifying a research question with high public health significance, (2) enhancing the intervention, and (3) improving research methods. Challenges included community coalition representatives' greater focus on their own communities rather than the production of broader scientific knowledge. This model can be applied in future attempts to narrow the gap between research, policy, and practice.

Exploring Community Stakeholders' Perceptions of the Enhancing Family Well-being Project in Hong Kong: A Qualitative Study

Background

Community engagement is a powerful tool in bringing about positive social and community change. Community stakeholders possess critical experience and knowledge that are needed to inform the development of community-based projects. However, limited literature is available on the practical experience involved with planning and implementing community-based family programs. Even less has been published documenting efforts in Chinese communities. This paper explores community stakeholders’ experiences with the enhancing family well-being project—part of a citywide project entitled the “FAMILY Project,” aimed at promoting family health, happiness, and harmony in Hong Kong.

Methods

This qualitative evaluation examined the perspectives of community stakeholders. Four focus groups with social workers (n = 24) and six in-depth interviews with steering committee members were conducted from December 2012 to May 2013 in Hong Kong. Focus groups and in-depths interview were audiotaped, transcribed, and analyzed using thematic analysis techniques.

Results

Rich accounts were given by our respondents on various aspects of the project. Main themes and subthemes were identified and grouped into four categories (project conception, project implementation, project consolidation, and the overall impact of the project). Respondents described the practical challenges associated with the project (e.g., recruitment, balancing scientific research, and lack of resources) and identified the elements that are important to the success of the project. These included the commitment to a shared goal, multi-agency collaboration, and a platform for knowledge exchange. Finally, respondents perceived benefits of the project at both the individual and community level.

Conclusion

Our project sheds light on many of the practical considerations and challenges associated with a designing and implementing a community-based family intervention project. Community stakeholders input provided important information on their perceived benefits and barriers and can inform and improve future development of community-based family intervention programs.

Grant writing: Moving from generating ideas to applying to grants that matter

There is an extraordinary burden placed upon the healthcare system and people as a result of health disparities that exist within the United States. If there is going to be a concerted effort to develop innovative strategies to reduce health disparities, input from the community and behavioral scientists can and should be included in this approach and narrative. Grant writing provides one vehicle to express the narrative and to provide a means to fund research and programs within clinic-based and community settings. This paper describes a four-step inquiry process to guide healthcare professionals with varying degrees of clinical and scholarship interests through the grant writing process. They include: (1) Why write grants (motivations), (2) what is the area of focus? (Interests), (3) whom should be on the project? (partnerships), and (4) what needs to happen next to move the idea forward? (actions) The complexity of psychosocial issues means that behavioral science is well suited to develop both hypotheses-driven and phenomenological research to understand bio-psycho-social health issues. Grant writing does not need to be mysterious or daunting. It can provide a means to an end, not only to fund research but also as a means to an end of health disparities.

Self-Care Behaviors of African Americans Living with Heart Failure

African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.

Critical discourse, applied inquiry and public health action with urban middle school students: Lessons learned engaging youth in critical service-learning

The Nuestro Futuro Saludable partnership designed a critical service-learning intervention focused on health equity and action. The ten-week afterschool intervention was implemented in a Boston middle school. Youths who took part in the intervention were knowledgeable about the social determinants of health in their communities, as well as to the barriers to health. Our findings indicate that engaging young people in a meaningful way will be critical if health improvement efforts are to be realized. We found that a critical service-learning framework that incorporates elements of applied inquiry and critical pedagogy was effective as a health intervention and provided opportunities for action.

Exploring the Life Course Perspective in Maternal and Child Health through Community-Based Participatory Focus Groups: Social Risks Assessment

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Treatment disparities among African American men with depression: implications for clinical practice

A decade has passed since the National Institute of Mental Health initiated its landmark Real Men Real Depression public education campaign. Despite increased awareness, depressed African American men continue to underutilize mental health treatment and have the highest all-cause mortality rates of any racial/ethnic group in the United States. We review a complex array of socio-cultural factors, including racism and discrimination, cultural mistrust, misdiagnosis and clinician bias, and informal support networks that contribute to treatment disparities. We identify clinical and community entry points to engage African American men. We provide specific recommendations for frontline mental health workers to increase depression treatment utilization for African American men. Providers who present treatment options within a frame of holistic health promotion may enhance treatment adherence. We encourage the use of multidisciplinary, community-based participatory research approaches to test our hypotheses and engage African American men in clinical research.

Tailored approach to sleep health education (TASHE): study protocol for a web-based randomized controlled trial

BACKGROUND

Obstructive sleep apnea (OSA) is a sleep disorder that disproportionately affects African Americans (hereafter referred to as blacks). Moreover, blacks may underutilize sleep services including overnight polysomnography. Thus, OSA among blacks may go undiagnosed and untreated, which has significant health consequences, including hypertension, diabetes, cognitive impairment, and daytime sleepiness.

DESIGN AND METHODS

This two-arm randomized controlled trial will assign 200 participants to a culturally and linguistically tailored web-based sleep educational platform. The website will be developed to ensure that the content is user friendly and that it is readable and acceptable by the target community. Participants will receive login information to a password-protected website and will have access to the website for 2 months. Study assessments will be collected at baseline, 2 months (post-enrollment) and at 6 months (follow-up). We will use qualitative and quantitative methods to develop tailored materials and to ascertain whether tailored materials will increase OSA knowledge and OSA health literacy by comparing blacks exposed to tailored materials versus those exposed to standard sleep health literature. We hypothesize that exposure to tailored OSA information will improve OSA health literacy.

DISCUSSION

Few studies have investigated the racial/ethnic disparities in relation to OSA screening and treatment comparing blacks and whites. Moreover, we know of no interventions designed to increase OSA knowledge and health literacy among blacks. Use of the Internet to disseminate health information is growing in this population. Thus, the Internet may be an effective means to increase OSA health literacy, thereby potentially increasing utilization of sleep-related services in this population.

TRIAL REGISTRATION

The study is registered at clinicaltrials.gov, reference number NCT02507089 . Registered on 21 July 2015.

Modeling the Principles of Community-Based Participatory Research in a Community Health Assessment Conducted by a Health Foundation

The authors discuss strategies used and lessons learned by a health foundation during development of a community health assessment model incorporating community-based participatory research (CBPR) approaches. The assessment model comprises three models incorporating increasing amounts of CPBR principles. Model A combines local-area analysis of quantitative data, qualitative information (key informants, focus groups), and asset mapping. Model B, a community-based participatory model, emphasizes participatory rural appraisal approaches and quantitative assessment using rapid epidemiological assessment. Model C, a modified version of Model B, is financially more sustainable for our needs than Model B. The authors (a) describe origins of these models and illustrate practical applications and (b) explore the lessons learned in their transition from a traditional, nonparticipatory, quantitative approach to participatory approaches to community-health assessment. It is hoped that this article will contribute to the growing body of knowledge of practical aspects of incorporating CBPR approaches into community health assessments.

The conceptualization of mistreatment by older American Indians

The problem of how to conceptualize elder mistreatment goes back several decades, and is especially important for ethnic minority populations, who may have perspectives that differ from the dominant society. This community-based participatory research study, which examined perceptions of mistreatment by family among 100 urban and rural older American Indians, permits a rare glimpse into how Native elders themselves understand this issue. Here, good treatment was conceptualized in terms of being taken care of, having one's needs met, and being respected. We found relatively high standards for how elders should be treated-such as the belief that an elder's needs should be anticipated and met without the elder needing to ask-in the face of widespread accounts of the mistreatment of elders within the community, largely through various acts of financial exploitation and neglect. Substance abuse and culture loss were blamed formuch of the elder mistreatment occurring in contemporary Native communities.

Meaningful engagement of people living with HIV who use drugs: methodology for the design of a Peer Research Associate (PRA) hiring model

Background

Community-based HIV, harm reduction, and addiction research increasingly involve members of affected communities as Peer Research Associates (PRAs)—individuals with common experiences to the participant population (e.g. people who use drugs, people living with HIV [PLHIV]). However, there is a paucity of literature detailing the operationalization of PRA hiring and thus limited understanding regarding how affected communities can be meaningfully involved through low-barrier engagement in paid positions within community-based participatory research (CBPR) projects. We aim to address this gap by describing a low-threshold PRA hiring process.

Results

In 2012, the BC Centre for Excellence in HIV/AIDS and the Dr. Peter AIDS Foundation collaborated to develop a mixed-method CBPR project evaluating the effectiveness of the Dr. Peter Centre (DPC)—an integrative HIV care facility in Vancouver, Canada. A primary objective of the study was to assess the impact of DPC services among clients who have a history of illicit drug use. In keeping with CBPR principles, affected populations, community-based organizations, and key stakeholders guided the development and dissemination of a low-barrier PRA hiring process to meaningfully engage affected communities (e.g. PLHIV who have a history of illicit drug use) in all aspects of the research project.

The hiring model was implemented in a number of stages, including (1) the establishment of a hiring team; (2) the development and dissemination of the job posting; (3) interviewing applicants; and (4) the selection of participants. The hiring model presented in this paper demonstrates the benefits of hiring vulnerable PLHIV who use drugs as PRAs in community-based research.

Conclusions

The provision of low-barrier access to meaningful research employment described herein attempts to engage affected communities beyond tokenistic involvement in research. Our hiring model was successful at engaging five PRAs over a 2-year period and fostered opportunities for future paid employment or volunteer opportunities through ongoing collaboration between PRAs and a diverse range of stakeholders working in HIV/AIDS and addictions. Additionally, this model has the potential to be used across a range of studies and community-based settings interested in meaningfully engaging communities in all stages of the research process.

Electronic supplementary material

The online version of this article (doi:10.1186/s12954-016-0116-z) contains supplementary material, which is available to authorized users.

Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center

Community-engaged researchers who work with low-income communities can be reliant on grant funding. We use the illustrative case of the Penn Center for Community Health Workers (PCCHW) to describe a step-by-step framework for achieving financial sustainability for community-engaged research interventions. PCCHW began as a small grant-funded research project but followed an 8-step framework to engage both low-income patients and funders, determine outcomes, and calculate return on investment. PCCHW is now fully funded by Penn Medicine and delivers the Individualized Management for Patient-Centered Targets (IMPaCT) community health worker intervention to 2000 patients annually.

Community readiness for adolescents' overweight and obesity prevention is low in urban South Africa: a case study

BACKGROUND

South Africa is undergoing epidemiological and nutrition transitions with associated increases in the incidence of overweight, obesity and diet-related chronic diseases. With the emergence of the nutrition transition in South Africa, there is an urgent need for interventions to prevent overweight and obesity in children and adolescents as risk factors for chronic diseases in adolescence may track throughout later life. This research explored the potential for faith-based organisations (FBOs) to be used as community organisations for overweight and obesity prevention interventions in adolescents by assessing the readiness of religious leaders to engage in such interventions.

METHODS

Surveys and focus group discussions (FGDs) were conducted with 51 religious leaders in Johannesburg and Soweto. The Community Readiness Model (CRM) survey was chosen to determine the stage of readiness of this community regarding overweight and obesity prevention. Six different dimensions were assessed in the CRM (community efforts, knowledge of efforts, leadership, community climate, knowledge of the issue, resources). The surveys were scored according to the CRM protocol. The survey data were supplemented with findings from FGDs. Thematic analysis was used to analyse the FGDs.

RESULTS

The mean community readiness score was 2.57 ± 0.76 which equates with the "denial/resistance stage". The mean readiness score for resources was the highest of all the dimensions (3.77 ± 0.28), followed by knowledge of the issue (3.20 ± 0.51). The lowest score was seen for community knowledge of efforts (1.77 ± 1.50), followed by community climate (2.00 ± 0.64). FGDs helped interpret the CRM scores. FGDs showed that religious leaders were enthusiastic and recognised that their role was not limited solely to spiritual guidance and mentoring, but also to physical well-being.

CONCLUSIONS

Religious leaders recognised that they act as role models within the community and thus have a role to play in improving adolescent health. They have some knowledge about the overweight/obesity issue and some of the resources could be made available to support overweight/obesity prevention-related initiatives. However, the low community knowledge of efforts and the negative prevailing attitude of the community towards overweight and obesity highlight the need to increase awareness of this issue prior to implementing initiatives on overweight and obesity prevention.

Through Their Eyes: Lessons Learned Using Participatory Methods in Health Care Quality Improvement Projects

In this methodological article, we examine participatory methods in depth to demonstrate how these methods can be adopted for quality improvement (QI) projects in health care. We draw on existing literature and our QI initiatives in the Department of Veterans Affairs to discuss the application of photovoice and guided tours in QI efforts. We highlight lessons learned and several benefits of using participatory methods in this area. Using participatory methods, evaluators can engage patients, providers, and other stakeholders as partners to enhance care. Participant involvement helps yield actionable data that can be translated into improved care practices. Use of these methods also helps generate key insights to inform improvements that truly resonate with stakeholders. Using participatory methods is a valuable strategy to harness participant engagement and drive improvements that address individual needs. In applying these innovative methodologies, evaluators can transcend traditional approaches to uniquely support evaluations and improvements in health care.

NETWORK STRUCTURE, MULTIPLEXITY, AND EVOLUTION AS INFLUENCES ON COMMUNITY-BASED PARTICIPATORY INTERVENTIONS

This study applies an ecological perspective to the context of community-based participatory research (CBPR). Specifically, it examines how endogenous and exogenous factors influence the dynamics of CBPR partnerships, including the tendency toward reciprocity and transitivity, the organizational type, the level of resource sufficiency, the level of organizational influence, and the perceived CBPR effect on organizations. The results demonstrate that network structure is related to the selection and retention of interorganizational networks over time, and organizations of the same type are more likely to form partnerships with each other. It shows that the dynamics of the CBPR initiative presented in this article were driven by the structure of the interorganizational networks rather than their individual organizational attributes. Implications for sustaining CBPR partnerships are drawn from the findings.

Elder mistreatment in underserved populations: Opportunities and challenges to developing a contemporary program of research

This article provides an overview of the status of research on elder mistreatment among underserved populations in the United States, including gaps in our current knowledge base and scientific and structural barriers to growing research on the exploitation, neglect, and abuse of older people from diverse and disadvantaged ethnic/racial, geographic, sexual identity, and socioeconomic groups. High-priority areas in need of new elder mistreatment research with underserved populations are identified, and suggestions are given for how this research can be facilitated by researchers, university institutional review boards, and funding agencies.

Inequitable Chronic Lead Exposure: A Dual Legacy of Social and Environmental Injustice

Both historic and contemporary factors contribute to the current unequal distribution of lead in urban environments and the disproportionate impact lead exposure has on the health and well-being of low-income minority communities. We consider the enduring impact of lead through the lens of environmental justice, taking into account well-documented geographic concentrations of lead, legacy sources that produce chronic exposures, and intergenerational transfers of risk. We discuss the most promising type of public health action to address inequitable lead exposure and uptake: primordial prevention efforts that address the most fundamental causes of diseases by intervening in structural and systemic inequalities.

Assessing HIV Prevention Provider Knowledge of Behavior Science Theory: Building on Existing Intuitive Experience

Behavioral science theory is recommended as a basis for prevention programs, yet many STD/HIV prevention providers have little academic background in this area and see no relevance of theory to their work. This study assessed STD/HIV prevention providers’ intuitive insight about behaviors. Comparisons of behavioral determinants from providers “common sense” theories with determinants identified in formal theories are made through the use of Theoretical Domains, a teaching tool designed to enhance the understanding and use of behavioral science in planning and implementing interventions. Understanding how to effectively apply behavior change concepts, combined with prevention providers’ basic, intuitive knowledge can enhance understanding, communication, and skills exchange between providers and researchers. Building capacity in local communities begins with a participatory process of community members, prevention providers, and researchers working together as equal partners. Better translation of research into practice using theory-based interventions will benefit the field of STD/HIV prevention.

Development of an Interviewer Training Manual for a Cervical Health Project on the Apsáalooke Reservation

This article describes strategies used to develop a survey interview training manual for use on the Apsáalooke (Crow Indian) Reservation and delineates how this process and product differed from those discussed in the extant literature on survey interview training. Working to ensure cultural appropriateness is especially important due to past research improprieties with Native American populations. This manual was developed as a part of a cervical health intervention program, Messengers for Health. Areas covered include goals of survey research, recruitment and enrollment, manner of the interviewer, nonverbal behavior, beginning the interview, and language use. Limitations of this work and suggestions for conducting survey research with Native American populations are also included.

Engagement practices that join scientific methods with community wisdom: designing a patient-centered, randomized control trial with a Pacific Islander community

This article illustrates how a collaborative research process can successfully engage an underserved minority community to address health disparities. Pacific Islanders, including the Marshallese, are one of the fastest growing US populations. They face significant health disparities, including extremely high rates of type 2 diabetes. This article describes the engagement process of designing patient-centered outcomes research with Marshallese stakeholders, highlighting the specific influences of their input on a randomized control trial to address diabetes. Over 18 months, an interdisciplinary research team used community-based participatory principles to conduct patient-engaged outcomes research that involved 31 stakeholders in all aspects of research design, from defining the research question to making decisions about budgets and staffing. This required academic researcher flexibility, but yielded a design linking scientific methodology with community wisdom.

Integrating expert knowledge in a GIS to optimize siting decisions for small-scale healthy food retail interventions

BACKGROUND

The availability of healthy foods in a neighborhood remains a key determinant of diet and diet-related disease in disadvantaged communities. Innovative solutions to the 'food desert' problem include the deployment of mobile markets and healthy corner store initiatives. Such initiatives, however, do not always capitalize on the principles guiding retail development and the possibilities of GIS-based data. Simultaneously, community partners are not always engaged effectively in the planning for such interventions, which limits acceptability and suitability of such work.

METHODS

This paper highlights the results of a participatory mapping exercise to optimize the siting of a planned healthy food retail intervention in Flint, Michigan. Potential sites are chosen by engaging experts in a three-stage mapping process that includes the analytic hierarchy process and point allocation of five key variables (including food access, socioeconomic distress, population density, access to transit, and proximity to neighborhood centers), as well as direct mapping of suitable sites.

RESULTS

Results suggest a discrete set of areas-primarily in the northwestern quadrant of the city-where small-scale healthy food retail interventions might be most strategically located. Areas with the most consistent overlap between directly mapped sites and very high levels of suitability align well with neighborhoods which are distant from existing grocery stores.

CONCLUSIONS

As a community-based strategy, this increases the opportunity for effectively improving neighborhood access to healthy foods by optimizing the potential sites for healthy food interventions. Community partners have already been active in using these results in project planning for just such an intervention.

At-risk adolescents as experts in a new requirements elicitation procedure for the development of a smart phone psychoeducational trauma-informed care application

BACKGROUND/PURPOSE

Adolescents from urban, socioeconomically disadvantaged communities of color encounter high rates of adverse childhood experiences. To address the resulting multidimensional problems, we developed an innovative approach, Experiential Participatory and Interactive Knowledge Elicitation (EPIKE), using remote experiential needs elicitation methods to generate design and content requirements for a mobile health (mHealth) psychoeducational intervention.

METHODS

At a community-based organization in a northeastern city, the research team developed EPIKE by incorporating elicitation of input on the graphics and conducting remotely recorded experiential meetings and iterative reviews of the design to produce an mHealth smartphone story application (app) prototype for the participants to critique. The 22 participants were 13- to 17-year-olds, predominantly African American and female, from underresourced communities.

RESULTS

The four goals of the design process were attained: 1) story development from participant input; 2) needs-elicitation that reflected the patient-centered care approach; 3) interactive story game creation that accommodates the participants' emotional and cognitive developmental needs; 4) development of a game that adolescents can relate to and that which matches their comfort levels of emotional intensity.

CONCLUSIONS

The EPIKE approach can be used successfully to identify the needs of adolescents across the digital divide to inform the design and development of mHealth apps.

Pediatric Prevention and Intervention in the Community

The health of children is largely influenced by the factors in their immediate environment, including their families, schools, and neighborhoods. However, according to Bronfenbrenner's ecological systems theory, children are also influenced by larger social systems that indirectly effect development, like the school system and the cultural values and traditions of the larger society. This issue of the Journal of Prevention and Intervention in the Community highlights research that investigates the importance of the various ecological systems on child health. Three articles focus on issues with particular relevance in pediatrics, including tobacco prevention, injury prevention, and sexually transmitted infection treatment. Two articles focus on community-engaged intervention programs to treat chronic childhood issues. Finally, one article focuses on the interaction between culture and pediatric health beliefs.

Engaging Pacific Islanders in Research: Community Recommendations

BACKGROUND

Health disparities continue to persist among Native Hawaiian and Pacific Islander (NHPI) communities.

OBJECTIVES

This study sought to understand the perspectives of community organizations in the Ulu Network on how researchers can collaborate with communities to promote community wellness.

METHODS

Key informant interviews and small group interviews were conducted with the leadership in the Ulu Network.

RESULTS

Five themes were identified that highlight the importance of investing time and commitment to build authentic relationships, understanding the diversity and unique differences across Pacific communities, ensuring that communities receive direct and meaningful benefits, understanding the organizational capacity, and initiating the dialog early to ensure that community perspectives are integrated in every stage of research.

CONCLUSIONS

Increasing capacity of researchers, as well as community organizations, can help build toward a more equitable and meaningful partnership to enhance community wellness.

Community-based fortified dietary intervention improved health outcomes among low-income African-American women

Poor dietary exposure disproportionately affects African-Americans and contributes to the persistence of disparities in health outcomes. In this study, we hypothesized that fortified dietary intervention (FDI) will improve measured dietary and related health outcomes and will be acceptable among low-income African-American women living in Tampa, FL. These objectives were tested using a prospective experimental study using pretest and posttest design with a control group, using a community-based participatory research approach. The intervention (FDI) was designed by the community through structural modification of a preexisting, diet-based program by the addition of a physical and mental health component. Paired sample t tests were used to examine preintervention and postintervention changes in study outcomes. A total of 49 women participated in the study, 26 in the FDI group and 23 controls. Two weeks postintervention, there were significant improvements in waist circumference and health-related quality of life related to physical health (P< .0001), physical fitness subscores (P= .002), and nutritional subscores (P= .001) in the FDI group. Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted. In the control group, a decrease in waist circumference was observed. Implementation of the FDI through a community-based participatory research approach is feasible and effective among low-income African-American women in general and overweight/obese women in particular. Social reengineering of a nutritional intervention coupled with community-based approach will enhance health outcomes of low-income women.

Using participant-empowered visual relationship timelines in a qualitative study of sexual behaviour

This study examines how the use of participant-empowered visual relationship timelines adds to the quality of an ongoing qualitative data collection in a case study examining the influence of emotions on sexual risk-taking and perceptions of HIV risk among men who have sex with men. Gay and bisexual men (n = 25) participated in a 10-week, three-phase study. During a baseline in-depth interview, participants created a visual timeline using labelled stickers to retrospectively examine their dating/sexual histories. Participants then completed three web-based quantitative personal relationship diaries, tracking sexual experiences during follow-up. These data were extracted and discussed in a timeline-based debrief interview. The visual cues assisted with data collection by prompting discussion through the immediate identification of patterns, opportunities for self-reflection, and rapport-building. The use of flexible data collection tools also allowed for a participant-empowered approach in which the participant controlled the interview process. Through this process, we learned strategies for improving a participant-empowered approach to qualitative research, including: allowing visual activities to drive the interview, using flexible guidelines to prompt activities, and using discrete imagery to increase participant comfort. It is important that qualitative data collection utilise more participatory approaches for gains in data quality and participant comfort.

Perceptions and Attitudes towards Medical Research in the United Arab Emirates: Results from the Abu Dhabi Cohort Study (ADCS) Focus Group Discussions

Background

In developing medical research, particularly in regions where medical research is largely unfamiliar, it is important to understand public perceptions and attitudes towards medical research. In preparation for starting the first cohort study in the United Arab Emirates, the Abu Dhabi Cohort Study (ADCS), we sought to understand how we could improve the quality of the research process for participants and increase public trust and awareness of research.

Methods

We conducted six focus groups (FG), consisting of Emirati men and women aged above 18 years to resemble the target population for the ADCS. Sampling was purposive and convenient. Data collection was an iterative process until saturation was reached with no new themes identified. Text from each FG was analyzed separately by identifying emerging issues and organizing related concepts into categories or themes. A coding tree was developed, consisting of the main concepts, themes, subthemes and corresponding quotes. Both themes and main ideas were identified using inductive analysis.

Results

Forty-two participants enrolled at 3 academic centers (New York University Abu Dhabi, UAE University, Zayed University) and the Abu Dhabi blood bank. Focus group participants described lack of awareness of research as a challenge to participation in clinical research studies. Altruism, personal relevance of the research, and the use of role models were commonly identified motivators. Participants were generally satisfied with the informed consent process for the ADCS, but would be disappointed if not provided test results or study outcomes. Fear of a breach in confidentiality was a frequently expressed concern.

Conclusions

Participants join research studies for varied, complex reasons, notably altruism and personal relevance. Based on these insights, we propose specific actions to enhance participant recruitment, retention and satisfaction in the ADCS. We identified opportunities to improve the research experience through improved study materials and communication to participants and the broader community.

Social media and gamification: Engaging vulnerable parents in an online evidence-based parenting program

The aim of this study was to examine the feasibility (accessibility, engagement and impact) of adding social media and gaming features (e.g., social sharing with anonymity, badges to incentivize skills practice, an accredited facilitator for support) and access via smartphones to an evidenced-based parenting program, Triple P Online. The highly vulnerable population included 155 disadvantaged, high-risk parents (e.g., 76% had a family annual income of less than $15,000; 41% had been incarcerated; 38% were in drug/alcohol treatment; and 24% had had a child removed due to maltreatment). The ethnic groups most commonly identified were African American (24%) and Hispanic (66%). Respondents were primarily mothers (86%) from five community programs in Los Angeles. The study used a single group repeated measures design (pre, post, 6-month follow-up). Data collected included standardized self-report measures, post-intervention focus groups and interviews, website usage reports, and Google Analytics. Significant multivariate ANOVA time effects were found, demonstrating reductions in child behavioral problems, reduced lax/permissive and over-reactive parenting, and decreased parental stress. No effects were found for parental confidence, attributions, or depression and anxiety (which were in the normal range at baseline). Positive effects were maintained or improved at 6-month follow-up. The participants engaged in the online community and valued its flexibility, anonymity, and shared learning. This foundational implementation trial provides support for future rigorous evaluation of social media and gaming features as a medium for increasing parental engagement in evidence-based parenting programs online--a public health approach to protect and improve the development of vulnerable children.

The Healthy Community Neighborhood Initiative: Rationale and Design

OBJECTIVE

To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multi-component study to understand and document health risk and resources in a low-income and minority community.

DESIGN

A community-partnered participatory research project.

SETTING

A low-income, biethnic African American and Latino neighborhood in South Los Angeles.

PARTICIPANTS

Adult community residents aged >18 years.

MAIN OUTCOME MEASURES

Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping.

RESULTS

We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants.

CONCLUSIONS

The HCNI community-academic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities.

Understanding Genomic Knowledge in Rural Appalachia: The West Virginia Genome Community Project

PURPOSE

Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia.

SAMPLE

A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time.

METHOD

A Community Based Participatory Research process with focus groups and demographic questionnaires was used.

FINDINGS

Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population.

CONCLUSIONS

Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.

Community-University Partnerships for Research and Practice: Application of an Interactive and Contextual Model of Collaboration

Community-university partnerships are frequently used to enhance translational research efforts while benefiting the community. However, challenges remain in evaluating such efforts. This article discusses the utility of applying the contextual and interactive model of community-university collaboration to a translational research education program, the Institute for Translational Research in Adolescent Behavioral Health, to guide programmatic efforts and future evaluations. Institute stakeholders from academia and the community completed in-depth interviews querying their expectations and experiences in this collaboration. Key quotes and themes were extracted and analyzed based on the constructs within the 3 phases of the model. The findings note specific themes for future evaluations. Overall, the contextual and interactive model of community-university collaboration proved a useful framework to guide the process evaluation of the Institute. Findings suggest possible strategies for the successful development, evaluation, and sustainability of community-university partnerships.

Bringing Community and Academic Scholars Together to Facilitate and Conduct Authentic Community Based Participatory Research: Project UNITED

Cultural competency, trust, and research literacy can affect the planning and implementation of sustainable community-based participatory research (CBPR). The purpose of this manuscript is to highlight: (1) the development of a CBPR pilot grant request for application; and (2) a comprehensive program supporting CBPR obesity-related grant proposals facilitated by activities designed to promote scholarly collaborations between academic researchers and the community. After a competitive application process, academic researchers and non-academic community leaders were selected to participate in activities where the final culminating project was the submission of a collaborative obesity-related CBPR grant application. Teams were comprised of a mix of academic researchers and non-academic community leaders, and each team submitted an application addressing obesity-disparities among rural predominantly African American communities in the US Deep South. Among four collaborative teams, three (75%) successfully submitted a grant application to fund an intervention addressing rural and minority obesity disparities. Among the three submitted grant applications, one was successfully funded by an internal CBPR grant, and another was funded by an institutional seed funding grant. Preliminary findings suggest that the collaborative activities were successful in developing productive scholarly relationships between researchers and community leaders. Future research will seek to understand the full-context of our findings.

A Systematic Review of Community Engagement in the US Environmental Protection Agency's Extramural Research Solicitations: Implications for Research Funders

OBJECTIVES

We systematically reviewed the Environmental Protection Agency, National Center for Environmental Research's (NCER's) requests for applications (RFAs) and identified strategies that NCER and other funders can take to bolster community engagement.

METHODS

We queried NCER's publically available online archive of funding opportunities from fiscal years 1997 to 2013. From an initial list of 211 RFAs that met our inclusion criteria, 33 discussed or incorporated elements of community engagement. We examined these RFAs along 6 dimensions and the degree of alignments between them.

RESULTS

We found changes over time in the number of RFAs that included community engagement, variations in how community engagement is defined and expected, inconsistencies between application requirements and peer review criteria, and the inclusion of mechanisms supporting community engagement in research.

CONCLUSIONS

The results inform a systematic approach to developing RFAs that support community engagement in research.

Community-Driven Research Agenda to Reduce Health Disparities

This paper describes how a new regional campus of an academic health center engaged in a community-based participatory research (CBPR) process to set a community-driven research agenda to address health disparities. The campus is situated among growing Marshallese and Hispanic populations that face significant health disparities. In 2013, with support from the Translational Research Institute, the University of Arkansas for Medical Sciences Northwest began building its research capacity in the region with the goal of developing a community-driven research agenda for the campus. While many researchers engage in some form of community-engaged research, using a CBPR process to set the research agenda for an entire campus is unique. Utilizing multiple levels of engagement, three research areas were chosen by the community: (1) chronic disease management and prevention; (2) obesity and physical activity; and (3) access to culturally appropriate healthcare. In only 18 months, the CBPR collaboration had dramatic results. Ten grants and five scholarly articles were collaboratively written and 25 community publications and presentations were disseminated. Nine research projects and health programs were initiated. In addition, many interprofessional educational and service learning objectives were aligned with the community-driven agenda resulting in practical action to address the needs identified.

Health-Related Quality of Life Among Cancer Survivors Attending Support Groups

There is limited research on the relationship between Health-related quality of life (HRQoL) and socioeconomic status (SES) among long-term cancer survivors. The goal of this study was to assess Global HRQoL among 102 adult cancer survivors attending support groups in San Diego County and to examine differences by SES and acculturation. Community-based participatory research methods were followed to recruit a purposive sample of English and Spanish-speaking adult cancer survivors attending cancer support groups. Self-report questionnaires assessing age, acculturation (i.e., language), SES (i.e., income and education), cancer history, and Global HRQoL measured by the FACT-G were administered. Multivariate regression examined the relationship between SES and acculturation with HRQoL, adjusting for covariates. Participants were 58.8 years on average (SD = 10.06) and varied in terms of SES. Most participants (91.5 %) were women, 51.7 % were non-Hispanic white, and 48.3 % were Hispanic/Latino. Global HRQoL scores in the study sample were lower compared to previously reported studies. After adjusting for covariates, SES and acculturation were not significantly related to HRQoL. Stage at diagnosis was significantly related to HRQoL measures in adjusted analyses. HRQoL did not vary by SES or acculturation. There is a need to increase access to linguistically and culturally appropriate cancer care and supportive care services. Future studies may find existing support group settings useful for targeting psychosocial issues for more advanced stage cancer survivors.

Challenges to establishing successful partnerships in community health promotion programs: local experiences from the national implementation of healthy eating activity and lifestyle (HEAL™) program

ISSUE ADDRESSED

Community-based programs to address physical activity and diet are seen as a valuable strategy to reduce risk factors for chronic disease. Community partnerships are important for successful local implementation of these programs but little is published to describe the challenges of developing partnerships to implement health promotion programs. The aim of this study was to explore the experiences and opinions of key stakeholders on the development and maintenance of partnerships during their implementation of the HEAL™ program.

METHOD

Semi-structured interviews with key stakeholders involved in implementation of HEAL™ in four local government areas. The interviews were transcribed verbatim and analysed thematically.

RESULTS

Partnerships were vital to the success of the local implementation. Successful partnerships occurred where the program met the needs of the partnering organisation, or could be adapted to do so. Partnerships took time to develop and were often dependent on key people. Partnering with organisations that had a strong influence in the community could strengthen existing relationships and success. In remote areas partnerships took longer to develop because of fewer opportunities to meet face to face and workforce shortages and this has implications for program funding in these areas.

CONCLUSION

Partnerships are important for the successful implementation of community preventive health programs. They take time to develop, are dependent on the needs of the stakeholders and are facilitated by stable leadership. SO WHAT?: An understanding of the role of partnerships in the implementation of community health programs is important to inform several aspects of program delivery, including flexibility in funding arrangements to allow effective and mutually beneficial partnerships to develop before the implementation phase of the program. It is important that policy makers have an understanding of the time it takes for partnerships to develop and to take this into consideration when programs are funded and implemented in the community.

Quantitative Evaluation of the Community Research Fellows Training Program

Context

The community research fellows training (CRFT) program is a community-based participatory research (CBPR) initiative for the St. Louis area. This 15-week program, based on a Master in Public Health curriculum, was implemented by the Division of Public Health Sciences at Washington University School of Medicine and the Siteman Cancer Center.

Objectives

We measure the knowledge gained by participants and evaluate participant and faculty satisfaction of the CRFT program both in terms of meeting learning objectives and actively engaging the community in the research process.

Participants

We conducted analyses on 44 community members who participated in the CRFT program and completed the baseline and follow-up knowledge assessments.

Main outcome measures

Knowledge gain is measured by a baseline and follow-up assessment given at the first and final session. Additionally, pre- and post-tests are given after the first 12 sessions. To measure satisfaction, program evaluations are completed by both the participants and faculty after each topic. Mid-way through the program, a mid-term evaluation was administered to assess the program’s community engagement. We analyzed the results from the assessments, pre- and post-tests, and evaluations.

Results

The CRFT participants’ knowledge increased at follow-up as compared with baseline on average by a 16.5 point difference (p < 0.0001). Post-test scores were higher than pre-test scores for 11 of the 12 sessions. Both participants and faculty enjoyed the training and rated all session well.

Conclusion

The CRFT program was successful in increasing community knowledge, participant satisfaction, and faculty satisfaction. This success has enhanced the infrastructure for CBPR as well as led to CBPR pilot projects that address health disparities in the St. Louis Greater Metropolitan Area.

Results of a community-based survey of construction safety climate for Hispanic workers

BACKGROUND

Hispanic construction workers experience high rates of occupational injury, likely influenced by individual, organizational, and social factors.

OBJECTIVES

To characterize the safety climate of Hispanic construction workers using worker, contractor, and supervisor perceptions of the workplace.

METHODS

We developed a 40-item interviewer-assisted survey with six safety climate dimensions and administered it in Spanish and English to construction workers, contractors, and supervisors. A safety climate model, comparing responses and assessing contributing factors was created based on survey responses.

RESULTS

While contractors and construction supervisors' (n = 128) scores were higher, all respondents shared a negative perception of safety climate. Construction workers had statistically significantly lower safety climate scores compared to supervisors and contractors (30·6 vs 46·5%, P<0·05). Safety climate scores were not associated with English language ability or years lived in the United States.

CONCLUSIONS

We found that Hispanic construction workers in this study experienced a poor safety climate. The Hispanic construction safety climate model we propose can serve as a framework to guide organizational safety interventions and evaluate safety climate improvements.