Team Science, Justice, and the Co-Production of Knowledge

Learning to make a difference for chILD: Value creation through network collaboration and team science

Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.

Critical realism, community psychology, and the curious case of autism: A philosophy and practice of science with social justice in mind

Community psychology (CP) is a transformative subdiscipline of psychology which aims to address inequality and social injustice and to attend to wellbeing. It has been argued that CP lacks an underpinning philosophy of science. Philosophies of science provide road maps for values, methods, and objectives, thus ultimately framing all research. This study will highlight how traditional philosophies of science such as positivism, interpretivism, and social constructivism fail to support the complexity of CP and often essentialise complex phenomena, such as autism, to the detriment of stakeholders. Critical realism will then be introduced as a promising philosophy of science for CP, which can reinvigorate CPs push for impactful research and social change. The study will highlight how CP provides a platform for appreciating the complexity of autism and for transforming structures of inequality experienced by autistic people, together with autistic people.

Protocol refinement for a diabetes pragmatic trial using the PRECIS-2 framework

Background

This report describes how we refined a protocol for a pragmatic comparative effectiveness study of two models of an evidence-based diabetes shared medical appointment intervention and used the PRECIS-2 rating system to evaluate these adaptations.

Methods

We report primary data collected between June and August 2019, and protocol refinements completed between 2018 and 2020. Twenty-two members of the study team collaborated in protocol refinement and completed the PRECIS-2 ratings of study pragmatism. We discuss study design refinements made to achieve the desired level of pragmatism vs. experimental control for each of the nine PRECIS-2 dimensions. Study team members received training on PRECIS-2 scoring and were asked to rate the study protocol on the nine PRECIS-2 dimensions. Ratings were compared using descriptive statistics.

Results

In general, the PRECIS-2 ratings revealed high levels of pragmatism, but somewhat less pragmatic ratings on the categories of Delivery and Organization (costs and resources). This variation was purposeful, and we provide the rationale for and steps taken to obtain the targeted level of pragmatism on each PRECIS-2 dimension, as well as detail design changes made to a) make the design more pragmatic and b) address COVID-19 issues. There was general agreement among team members and across different types of stakeholders on PRECIS-2 ratings.

Conclusions

We discuss lessons learned from use of PRECIS-2 and experiences in refining the study to be maximally pragmatic on some dimensions and less so on other dimensions. This paper expands on prior research by describing actions to achieve higher levels of pragmatism and revise our protocol fit to the changed context. We make recommendations for future use of PRECIS-2 to help address changing context and other strategies for the planning of and transparent reporting on pragmatic research and comparative effectiveness research.

Trial registration

Clinicaltrials.gov Registration ID: NCT03590041.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07084-x.

Scales of Practices and Outcomes for Community-Engaged Research

Despite the growth of research on community-engaged research (CEnR), recent reviews suggest there has been limited development of validated scales to measure key contexts, mechanisms, and outcomes, impairing testing and refinement of theoretical models. The purpose of this study is to present the psychometric properties of scales from the Engage for Equity (E2) project, stemming from a long-term research partnership examining community-engaged research projects. This study used a three-stage, cross-sectional format: (a) a sampling frame of 413 CEnR projects was identified; (b) 210 principal investigators completed a project-level survey and nominated partners for another survey; (c) 457 investigators and partners completed a survey about project contexts, processes, interventions, and outcomes. Factorial validity was established through confirmatory factor analysis supporting seven scales: contextual capacity, commitment to collective empowerment, relationships, community engagement in research actions, synergy, partner and partnership transformation, and projected outcomes. Convergent validity was established through examining covariances among the scales. This study largely yielded results consistent with a previous psychometric study of related measures, while demonstrating improved ceiling effects of the items and refined conceptualization of core theoretical constructs.

Meaningful Engagement in Research: Community Residents as Co-creators of Knowledge

Community psychologists have contributed significantly to the body of literature on community-based participatory research (CBPR) and its application in understanding and addressing health and community participation disparities. At the core of CBPR are mutually beneficial partnerships with communities, whereby community members' voices are heard and they become co-researchers, helping guide the research process. In this article, I argue that for community psychologists to change the landscape of community participation, health, and well-being disparities experienced by many vulnerable populations who often face multiple forms of oppression, CBPR needs to be transformative and emancipatory. Stakeholders must be meaningfully involved as co-creators of knowledge and promoters of social justice embracing a human rights agenda. Drawing from work conducted with Latinx immigrant families with youth who have disabilities, I propose the following strategies moving forward: promoting meaningful participation of community members as co-creators of knowledge; promoting meaningful conversations that matter to communities; promoting civic engagement, activism, and advocacy; promoting an assets- and strengths-based approach to research; and promoting culturally relevant interventions. Community psychologists have the opportunity to make significant contributions to addressing disparities when community residents' knowledge is valued and recognized.

An Intervention Science to Advance Underrepresented Perspectives and Indigenous Self-Determination in Health

This concluding article to the Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States draws themes and conclusions from the innovative practices implemented by the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortium. The IRINAH work highlights promising practices for advancing the diverse and underrepresented perspectives essential to develop and test culturally appropriate, effective health interventions in American Indian, Alaska Native, and Native Hawaiian settings. Four emergent themes appear through the IRINAH work. First, community-based participatory research (CBPR) has provided projects an intersectional worldview for bridging cultures and informing an ethics of local control. Second, culture is fundamental as a central organizing principle in IRINAH research and intervention implementation. Third, crucial demands for sustainability of interventions in Indigenous intervention science require a rethinking of the intervention development process. Finally, tensions persist in Indigenous health research, even as significant strides are made in the field. These themes collectively inform an ethical and rigorous Indigenous intervention science. Collectively, they suggest a roadmap for advancing Indigenous perspectives and self-determination in health intervention research. IRINAH studies are leading innovation in intervention science by advancing applications of CBPR in intervention science, promoting new directions in small populations health research, and demonstrating value of participatory team science.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

LESSONS LEARNED

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

Population Health and Trauma-Informed Practice: Implications for Programs, Systems, and Policies

Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma-informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re-traumatization. Current trauma-informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma-informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma-informed practice. We then discuss implications of these principles by identifying four priorities for trauma-informed practice from a population health perspective: (a) adopting trauma-informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma-informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma-informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma-informed principles for population health impact.

With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska

This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.

Community Science as a Pathway for Resilience in Response to a Public Health Crisis in Flint, Michigan

While the story of the Flint water crisis has frequently been told, even sympathetic analyses have largely worked to make invisible the significant actions of Flint residents to protect and advocate for their community. Leaving the voices of these stakeholders out of narratives about the crisis has served to deepen distrust in the community. Our project responds to these silences through a community-driven research study aimed explicitly at elevating the frame of Flint residents in and around the Flint water crisis. This paper describes the coming together of the research team, the overall project design for each of the three research efforts, and lessons learned. The three sub-projects include: (1) a qualitative analysis of community sentiment provided during 17 recorded legislative, media, and community events, (2) an analysis of trust in the Flint community through nine focus groups across demographic groups (African American, Hispanic, seniors, and youth) of residents in Flint, and (3) an analysis of the role of the faith-based community in response to public health crises through two focus groups with faith based leaders from Flint involved with response efforts to the water crisis. Our study offers insight for understanding trust in crisis, which could be valuable to other communities and researchers seeking to address similar situations. The project offers community science as a model for considering community engagement in research as part of the process of resilience.