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Malika N, Herman PM, Whitley M, Coulter I, Maiers M, Chesney M, Rogers R. Qualitative Assessment CIH Institutions' Engagement With Underserved Communities to Enhance Healthcare Access and Utilization. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241244759. [PMID: 38545335 PMCID: PMC10966973 DOI: 10.1177/27536130241244759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 05/26/2024]
Abstract
Background In North America, there is a notable underutilization of complementary and integrative health approaches (CIH) among non-White and marginalized communities. Objectives This study sought to understand how CIH educational instutitions are proactively working to redress this disparity in access and utilization among these communities. Methods We conducted interviews with 26 key informants, including presidents, clinicians, and research deans across 13 CIH educational institutions across the US and Canada. Thematic analysis included deductive codes based on the interview guide during interview scripts review. Results Six themes were identified: (1) CIH institutions often had a long and varied history of community engaged care through partnerships to increase access and utilization; (2) CIH institutions' long-standing community outreach had been intentionally designed; (3) CIH institutions provided an array of services to a wide range of demographics and communities; (4) addressing healthcare access and utilization through community partnerships had a strong positive impact; (5) funding, staffing and COVID-19 were significant challenges that impeded efforts to increase CIH access through community engaged work; (6) identified gaps in community partnerships and services to increase access and utilization were recognized. Conclusion These findings underscore significant efforts made to enhance healthcare access and utilization among marginalized, underserved, and racial and ethnic communities. However, barriers such as funding constraints, resource allocation, and the need for proper measurement and accountability hinder proactive initiatives aimed at redressing disparities in CIH utilization within these communities.
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Affiliation(s)
| | | | | | | | - Michele Maiers
- Northwestern Health Sciences University, Bloomington, MN, USA
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Damas OM, Maldonado-Contreras A. Breaking Barriers in Dietary Research: Strategies to Diversify Recruitment in Clinical Studies and Develop Culturally Tailored Diets for Hispanic Communities Living With Inflammatory Bowel Disease. Gastroenterology 2023; 165:324-328. [PMID: 37479360 DOI: 10.1053/j.gastro.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Oriana M Damas
- Crohn's and Colitis Center, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, Program of Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Damas OM, Maldonado-Contreras A. Breaking Barriers in Dietary Research: Strategies to Diversify Recruitment in Clinical Studies and Develop Culturally Tailored Diets for Hispanic Communities Living With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2023; 21:2169-2173. [PMID: 37482405 DOI: 10.1016/j.cgh.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Oriana M Damas
- Crohn's and Colitis Center, Division of Digestive Health and Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Ana Maldonado-Contreras
- Department of Microbiology and Physiological Systems, Program of Microbiome Dynamics, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Termansen T, Bloch P, Tørslev MK, Vardinghus-Nielsen H. Tingbjerg Changing Diabetes: experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighbourhood in Copenhagen, Denmark. BMC Public Health 2023; 23:392. [PMID: 36841764 PMCID: PMC9958318 DOI: 10.1186/s12889-023-15291-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study provides important insights on the role of context and how it contributes complexity in community-based health promotion.The study is based on 18 months of ethnographic fieldwork in the local community including participant observations and 9 in-depth interviews with key partner representatives. Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners' navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness. The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.
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Affiliation(s)
- Tina Termansen
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark. .,Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Paul Bloch
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Mette Kirstine Tørslev
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Henrik Vardinghus-Nielsen
- Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Witt WP, Harlaar N, Palmer A. The Impact of COVID-19 on Pregnant Women and Children: Recommendations for Health Promotion. Am J Health Promot 2023; 37:282-288. [PMID: 36646662 DOI: 10.1177/08901171221140641e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
COVID-19 continues to have severe repercussions on children and pregnant women. The repercussions include not only the direct impact of COVID-19 (ie, children getting infected by COVID-19) but also indirect impacts (eg, safeguarding from child maltreatment, obesogenic behaviors, language and socioemotional development, educational consequences [eg, interrupted learning]; social isolation; mental health; behavioral health [eg, increased substance use in adolescence]; health and economic impact of COVID-19 on caregivers and family relationships. It has also shed light on long-standing structural and socioeconomic issues, including equity in nutrition and food security, housing, childcare, and internet access. Using a socioecological, life course, and population health approach, we discuss the implications for pregnant women and children's health and well-being and give recommendations for mitigating the short and long-term deleterious impact COVID- 19 on women, children, and their families.
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"It has to be designed in a way that really challenges people's assumptions": preparing scholars to build equitable community research partnerships. J Clin Transl Sci 2021; 5:e182. [PMID: 34849257 PMCID: PMC8596064 DOI: 10.1017/cts.2021.858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/07/2022] Open
Abstract
Introduction: Clinical and Translational Award (CTSA) programs are developing relevant training for researchers and community stakeholders participating in community-engaged research (CEnR). However, there is limited research exploring the ways community stakeholders and partners with key CEnR experiences can inform and shape training priorities for prospective CEnR scholars to build meaningful and equitable partnerships. Methods: This study conducted and analyzed online individual semi-structured in-depth interviews with community stakeholders (n = 13) engaged in CEnR to identify training priorities for graduate students and emerging scholars. Findings: Thematic analysis of 13 interview transcripts revealed four major training priorities for prospective scholars interested in engaging in CEnR: 1) researcher’s positionality, 2) equitable power sharing, 3) funding, and 4) ethics. Conclusion: Building equitable research partnerships was a central theme woven across all four training priorities. Further research should focus on examining the development, implementation, and evaluation of CEnR training in partnership with community stakeholders and partners with relevant CEnR experience. Adopting a collaborative approach to incorporate both community stakeholders and researchers’ priorities can align training competencies to better prepare scholars to engage in building research partnerships.
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Heredia D, Pankey TL, Gonzalez CA. LGBTQ-Affirmative Behavioral Health Services in Primary Care. Prim Care 2021; 48:243-257. [PMID: 33985702 DOI: 10.1016/j.pop.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Behavioral health concerns related to sexual and gender minority stress impair functioning and limit quality of life. With greater interest in implementing LGBTQ-affirmative health care practices, primary care providers likely will see larger numbers of LGBTQ individuals presenting with behavioral health concerns. Behavioral health and medical providers may not feel prepared to address the biological, psychological, social, and cultural minority stress factors that have an impact on LGBTQ patients. LGBTQ-affirmative behavioral health providers in primary care can offer a unique service by conducting tailored evaluations and individualized interventions targeting multifactorial influences that cause and perpetuate psychological distress in LGBTQ patients.
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Affiliation(s)
- Dagoberto Heredia
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Tyson L Pankey
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Cesar A Gonzalez
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Mendoza Diaz A, Leslie A, Burman C, Best J, Goldthorp K, Eapen V. School-based integrated healthcare model: how Our Mia Mia is improving health and education outcomes for children and young people. Aust J Prim Health 2021; 27:71-75. [PMID: 33731251 DOI: 10.1071/py20177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/16/2020] [Indexed: 11/23/2022]
Abstract
Integrating healthcare into education settings represents a promising model to address complex health problems in disadvantaged communities through improving access to health and social services. One such example of an effective school-based health hub is the Our Mia Mia (OMM) Wellbeing Hub, located in a primary school in Nowra and servicing a community experiencing significant socioeconomic disadvantage. The efficacy of OMM rests on its success in facilitating access to services by removing the barriers of cost and transport and establishing connection to community. The OMM fosters collaborations between health professionals and educators to coordinate holistic treatment and implement appropriate student supports in a timely manner. The support of key individuals and groups, in addition to the flexibility of the model, has allowed the hub to pivot and adapt to meet the changing needs of its community, particularly as challenges pertaining to bureaucracy, financial sustainability and community mistrust have presented themselves. Future directions for the OMM hub, and the possibility of adapting and translating school-based healthcare delivery models in other disadvantaged communities, is discussed.
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Affiliation(s)
- Antonio Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia; and Infant Child and Adolescent Mental Health Services (ICAMHS), South Western Sydney Local Health District (SWSLHD), Liverpool, NSW 2170, Australia; and Corresponding author
| | - Andrew Leslie
- Our Mia Mia, Australia, 87 Jervis Street, Nowra, NSW 2541, Australia
| | - Charlotte Burman
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia; and Ingham Institute, 1 Campbell Street, Liverpool, NSW 2170, Australia
| | - James Best
- Our Mia Mia, Australia, 87 Jervis Street, Nowra, NSW 2541, Australia
| | - Kristie Goldthorp
- Nowra East Public School, 87 Jervis Street, Nowra, NSW 2541, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia
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Carolan K, Charlot M, Gawuga C, Freeman E, Kim JH, Sprague Martinez L. Assessing cancer center researcher and provider perspectives on patient engagement. Transl Behav Med 2020; 10:1573-1580. [PMID: 31560395 DOI: 10.1093/tbm/ibz132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
| | - Marjory Charlot
- Division of Hematology and Oncology, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Cyrena Gawuga
- Macro Department, Boston University School of Social Work, Boston, MA
| | - Elmer Freeman
- Center for Community Health Education Research and Service, Inc, Boston, MA
| | - Ji Hyang Kim
- Macro Department, Boston University School of Social Work, Boston, MA
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Luger TM, Hamilton AB, True G. Measuring Community-Engaged Research Contexts, Processes, and Outcomes: A Mapping Review. Milbank Q 2020; 98:493-553. [PMID: 32428339 PMCID: PMC7296434 DOI: 10.1111/1468-0009.12458] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Policy Points Community‐engaged research (CEnR) engenders meaningful academic‐community partnerships to improve research quality and health outcomes. CEnR has increasingly been adopted by health care systems, funders, and communities looking for solutions to intractable problems. It has been difficult to systematically measure CEnR's impact, as most evaluations focus on project‐specific outcomes. Similarly, partners have struggled with identifying appropriate measures to assess outcomes of interest. To make a case for CEnR's value, we must demonstrate the impacts of CEnR over time. We compiled recent measures and developed an interactive data visualization to facilitate more consistent measurement of CEnR's theoretical domains.
Context Community‐engaged research (CEnR) aims to engender meaningful academic‐community partnerships to increase research quality and impact, improve individual and community health, and build capacity for uptake of evidence‐based practices. Given the urgency to solve society's pressing public health problems and increasing competition for funding, it is important to demonstrate CEnR's value. Most evaluations focus on project‐specific outcomes, making it difficult to demonstrate CEnR's broader impact. Moreover, it is challenging for partnerships to identify assessments of interest beyond process measures. We conducted a mapping review to help partnerships find and select measures to evaluate CEnR projects and to characterize areas where further development of measures is needed. Methods We searched electronic bibliographic databases using relevant search terms from 2009 to 2018 and scanned CEnR projects to identify unpublished measures. Through review and reduction, we found 69 measures of CEnR's context, process, or outcomes that are potentially generalizable beyond a specific health condition or population. We abstracted data from descriptions of each measure to catalog purpose, aim (context, process, or outcome), and specific domains being measured. Findings We identified 28 measures of the conditions under which CEnR is conducted and factors to support effective academic‐community collaboration (context); 43 measures evaluating constructs such as group dynamics and trust (process); and 43 measures of impacts such as benefits and challenges of CEnR participation and system and capacity changes (outcomes). Conclusions We found substantial variation in how academic‐community partnerships conceptualize and define even similar domains. Achieving more consistency in how partnerships evaluate key constructs could reduce measurement confusion apparent in the literature. A hybrid approach whereby partnerships discuss common metrics and develop locally important measures can address CEnR's multiple goals. Our accessible data visualization serves as a convenient resource to support partnerships’ evaluation goals and may help to build the evidence base for CEnR through the use of common measures across studies.
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Affiliation(s)
- Tana M Luger
- VA Greater Los Angeles Healthcare System, Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy
| | - Alison B Hamilton
- VA Greater Los Angeles Healthcare System, Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy.,David Geffen School of Medicine, University of California, Los Angeles
| | - Gala True
- Southeast Louisiana Veterans Healthcare System, South Central Mental Illness Research, Education, and Clinical Center.,Louisiana State University School of Medicine, Section of Community and Population Medicine
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Brush BL, Mentz G, Jensen M, Jacobs B, Saylor KM, Rowe Z, Israel BA, Lachance L. Success in Long-Standing Community-Based Participatory Research (CBPR) Partnerships: A Scoping Literature Review. HEALTH EDUCATION & BEHAVIOR 2019; 47:556-568. [PMID: 31619072 DOI: 10.1177/1090198119882989] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Community-based participatory research (CBPR) is increasingly used by community and academic partners to examine health inequities and promote health equity in communities. Despite increasing numbers of CBPR partnerships, there is a lack of consensus in the field regarding what defines partnership success and how to measure factors contributing to success in long-standing CBPR partnerships. Aims. To identify indicators and measures of success in long-standing CBPR partnerships as part of a larger study whose aim is to develop and validate an instrument measuring success across CBPR partnerships. Methods. The Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided searches of three databases (PubMed, CINAHL, Scopus) for articles published between 2007 and 2017 and evaluating success in CBPR partnerships existing longer than 4 years. Results. Twenty-six articles met search criteria. We identified 3 key domains and 7 subdomains with 28 underlying indicators of success. Six partnerships developed or used instruments to measure their success; only one included reliability or validity data. Discussion. CBPR partnerships reported numerous intersecting partner, partnership, and outcome indicators important for success. These results, along with data from key informant interviews with community and academic partners and advisement from a national panel of CBPR experts, will inform development of items for an instrument measuring CBPR partnership success. Conclusion. The development of a validated instrument measuring indicators of success will allow long-standing CBPR partnerships to evaluate their work toward achieving health equity and provide a tool for newly forming CBPR partnerships aiming to achieve long-term success.
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‘Come Back at Us’: Reflections on Researcher-Community Partnerships during a Post-Oil Spill Gulf Coast Resilience Study. SOCIAL SCIENCES-BASEL 2019. [DOI: 10.3390/socsci8010008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents findings from eight post-hoc interviews with individuals representing the key community partner organizations that facilitated and hosted data collection for an in-person mixed-methods survey about disaster resilience and preparedness in three communities on the Gulf Coast (U.S.) impacted by the Deepwater Horizon oil spill and numerous disasters from natural hazards. We submit our analysis of these follow-up interviews with community partners as a case study to provide a set of recommendations for future community-engaged research practices, particularly in the field of environmental and disaster resilience. Input from community partners stressed the importance of engaging with local community brokers to enhance trust in research; researcher-partner communication; and researcher interaction with community residents that respects local knowledge and culture. The partners indicated that even communities that have often been the subjects of post-disaster studies are receptive to research participation, especially when the effects of disasters are long-term and ongoing. Recommendations include using research methodologies that are congruent with post-disaster community characteristics such as educational attainment; collaborating with community partners to disseminate research findings; and incorporating theories and practices that center critical reflection and consider power dynamics when working with communities that have experienced disaster and trauma.
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Davids AH, Sommese KJ, Roach MV, Lee SJ, Crose CE, Khan SB, Leader AP. Clínica Comunitaria Esperanza: Strategy for Health Promotion and Engagement With Hispanic Communities. Health Promot Pract 2018; 21:91-96. [PMID: 30103623 DOI: 10.1177/1524839918784942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 2009 community needs assessment highlighted the health care gap facing Hispanic residents in Hampton, Virginia, one of the major cities served by Eastern Virginia Medical School (EVMS). Survey respondents indicated the following as health care barriers: language, lack of knowledge, and lack of a community health center. EVMS students worked to bridge the health care gap between existing needs and services by establishing and maintaining the Clínica Comunitaria Esperanza, a culturally and linguistically competent student-run free clinic serving uninsured Hispanics in the Hampton Roads area. This article provides a model for engaging effectively with a priority population through partnerships that facilitate understanding of the community concerns, values, culture, and existing local resources that serve as determinants of health. This article further illustrates how the integration of two preexisting EVMS programs, the HOPES (Health Outreach Partnership of EVMS Students) Clinic and the Medical Spanish program, has supported the development and sustainability of Clínica Comunitaria Esperanza. The HOPES Clinic is a student-run free clinic that provides both general and specialty care to uninsured patients. EVMS' Medical Spanish program is a longitudinal service learning initiative composed of medical students, faculty, and staff dedicated to providing inclusive health care to meet the needs of the local Spanish-speaking community.
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Affiliation(s)
| | | | | | - Samuel J Lee
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Sarah B Khan
- Eastern Virginia Medical School, Norfolk, VA, USA
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Dillon FR, Ertl MM, Corp DA, Babino R, De La Rosa M. Latina young adults' use of health care during initial months in the United States. Health Care Women Int 2018; 39:343-359. [PMID: 29043912 PMCID: PMC6089526 DOI: 10.1080/07399332.2017.1388382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined social ecological predictors of health care utilization among Latina young adults during their initial year after immigration to the United States. Participants were 530 Latinas (ages 18-23) who immigrated to Miami-Dade County, Florida, 11.5 months before assessment. We used multiple logistic regression to test predictors of health care usage. Approximately 36% utilized care. Dimensions of marianismo differentially associated with usage. Usage also was more likely for participants who reported more social network attachment, better health, greater neighborhood cohesion, and possessed a job and health insurance. Findings inform interventions to increase health care usage globally among women after immigration.
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Affiliation(s)
- Frank R Dillon
- a Department of Counseling & Counseling Psychology , Arizona State University , Tempe , Arizona , USA
| | - Melissa M Ertl
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Dylan A Corp
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Rosa Babino
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
| | - Mario De La Rosa
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
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Dave G, Frerichs L, Jones J, Kim M, Schaal J, Vassar S, Varma D, Striley C, Ruktanonchai C, Black A, Hankins J, Lovelady N, Cene C, Green M, Young T, Tiwari S, Cheney A, Cottler L, Sullivan G, Brown A, Burke J, Corbie-Smith G. Conceptualizing trust in community-academic research partnerships using concept mapping approach: A multi-CTSA study. EVALUATION AND PROGRAM PLANNING 2018; 66:70-78. [PMID: 29053983 PMCID: PMC5705432 DOI: 10.1016/j.evalprogplan.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 05/16/2023]
Abstract
OBJECTIVES Collaborations between communities, healthcare practices and academic institutions are a strategy to address health disparities. Trust is critical in the development and maintaining of effective collaborations. The aim of this pilot study was to engage stakeholders in defining determinants of trust in community academic research partnerships and to develop a framework for measuring trust. METHODS The study was conducted by five collaborating National Institute of Health' Clinical and Translational Sciences Awardees. We used concept mapping to engage three stakeholders: community members, healthcare providers and academicians. We conducted hierarchical cluster analysis to assess the determinants of trust in community-academic research partnerships. RESULTS A total of 186 participants provided input generating 2,172 items that were consolidated into 125 unique items. A five cluster solution was defined: authentic, effective and transparent communication; mutually respectful and reciprocal relationships; sustainability; committed partnerships; and, communication, credibility and methodology to anticipate and resolve problems. CONCLUSION Results from this study contribute to an increasing empirical body of work to better understand and improve the underlying factors that contribute to building and sustaining trust in community academic research partnerships.
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Affiliation(s)
- Gaurav Dave
- University of North Carolina-Chapel Hill, United States.
| | - Leah Frerichs
- University of North Carolina-Chapel Hill, United States
| | | | | | | | | | | | | | | | - Adina Black
- University of North Carolina-Chapel Hill, United States
| | | | | | - Crystal Cene
- University of North Carolina-Chapel Hill, United States
| | - Melissa Green
- University of North Carolina-Chapel Hill, United States
| | - Tiffany Young
- University of North Carolina-Chapel Hill, United States
| | | | - Ann Cheney
- University of California-Riverside, United States
| | | | | | - Arleen Brown
- University of California-Los Angeles, United States
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Gimpel N, Pagels P, Kindratt T. Community action research experience (CARE): training family physicians in community based participatory research. EDUCATION FOR PRIMARY CARE 2017; 28:334-339. [PMID: 28245361 DOI: 10.1080/14739879.2017.1295789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nora Gimpel
- a Department of Family and Community Medicine , University of Texas Southwestern Medical School , Dallas , TX , USA
| | - Patti Pagels
- a Department of Family and Community Medicine , University of Texas Southwestern Medical School , Dallas , TX , USA
| | - Tiffany Kindratt
- b Department of Physician Assistant Studies , University of Texas Southwestern School of Health Professions , Dallas , TX , USA
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18
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Alicea-Alvarez N, Foppiano Palacios C, Ortiz M, Huang D, Reeves K. Path to health asthma study: A survey of pediatric asthma in an urban community. J Asthma 2016; 54:273-278. [PMID: 27485682 DOI: 10.1080/02770903.2016.1216564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Minority children with asthma who live in low-income urban communities bear a disproportionate burden of the disease. This study explores the perceived health care needs related to asthma care, identifies asthma triggers, potential barriers to care, and assesses the need for additional community resources. METHODS We conducted a cross-sectional survey of Hispanic and African American adults (n = 53) who take care of a child with asthma and live in an urban community of North Philadelphia. Input from community leaders was obtained in the development the survey tool resulting in a unique 'community-centric' questionnaire. The survey was also available in Spanish. All surveys were conducted in the community setting. RESULTS Variables were used to measure asthma severity and triggers. Children were categorized with intermittent (n = 24, 45.3%), mild persistent (n = 13, 24.5%), or moderate-to-severe persistent asthma (n = 16, 30.2%). Most children with persistent asthma were enrolled under Medicaid or CHIP (n = 24, p = 0.011) and reflected a low-income socioeconomic status. Persistent asthma was found to be associated with most triggers: pets, dust mites, mice, mold, and cockroaches. There was no significant association between environmental tobacco smoke and persistent asthma. Children with persistent asthma and 2 or more triggers were more likely to be hospitalized and go to the Emergency Department. CONCLUSION Urban minority children living in low-income communities face neighborhood-specific asthma triggers and challenges to care. Studies conducted in urban neighborhoods, with collaboration from community members, will highlight the need of comprehensive services to account for community-centric social determinants.
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Affiliation(s)
| | - Carlo Foppiano Palacios
- b Internal Medicine/Pediatrics, University of Maryland Medical Center , Baltimore , MD , USA
| | - Melanie Ortiz
- c Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
| | - Diana Huang
- c Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
| | - Kathleen Reeves
- d Office of Health Equity, Diversity and Inclusion Director, Center for Bioethics, Urban Health, and Policy, Lewis Katz School of Medicine, Temple University , Philadelphia , PA , USA
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Frerichs L, Kim M, Dave G, Cheney A, Hassmiller Lich K, Jones J, Young TL, Cene CW, Varma DS, Schaal J, Black A, Striley CW, Vassar S, Sullivan G, Cottler LB, Brown A, Burke JG, Corbie-Smith G. Stakeholder Perspectives on Creating and Maintaining Trust in Community-Academic Research Partnerships. HEALTH EDUCATION & BEHAVIOR 2016; 44:182-191. [PMID: 27230272 DOI: 10.1177/1090198116648291] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-academic research partnerships aim to build stakeholder trust in order to improve the reach and translation of health research, but there is limited empirical research regarding effective ways to build trust. This multisite study was launched to identify similarities and differences among stakeholders' perspectives of antecedents to trust in research partnerships. In 2013-2014, we conducted a mixed-methods concept mapping study with participants from three major stakeholder groups who identified and rated the importance of different antecedents of trust on a 5-point Likert-type scale. Study participants were community members ( n = 66), health care providers ( n = 38), and academic researchers ( n = 44). All stakeholder groups rated "authentic communication" and "reciprocal relationships" the highest in importance. Community members rated "communication/methodology to resolve problems" ( M = 4.23, SD = 0.58) significantly higher than academic researchers ( M = 3.87, SD = 0.67) and health care providers ( M = 3.89, SD = 0.62; p < .01) and had different perspectives regarding the importance of issues related to "sustainability." The importance of communication and relationships across stakeholders indicates the importance of colearning processes that involve the exchange of knowledge and skills. The differences uncovered suggest specific areas where attention and skill building may be needed to improve trust within partnerships. More research on how partnerships can improve communication specific to problem solving and sustainability is merited.
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Affiliation(s)
- Leah Frerichs
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mimi Kim
- 2 Duke University, Durham, NC, USA
| | - Gaurav Dave
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ann Cheney
- 3 University of California, Riverside, CA, USA
| | | | | | - Tiffany L Young
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Crystal W Cene
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jennifer Schaal
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adina Black
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | - Arleen Brown
- 5 University of California, Los Angeles, CA, USA
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Moreno G, Mangione CM, Meza CE, Kwon I, Seeman T, Trejo L, Moore M, Sarkisian CA. Perceptions from latino and african american older adults about biological markers in research. Ethn Dis 2016; 25:355-62. [PMID: 26347148 DOI: 10.18865/ed.25.3.355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Although older adult minorities face disparities in health and health care, they continue to be underrepresented in health research. Studies with biological markers of health often lack representation of older minority adults. The purpose of this study was to describe perceptions of biomarkers among ethnic minority seniors who might participate in studies of biological markers of health and to document barriers and facilitators to acceptance of biomarkers. Six focus groups (3 of Spanish-speaking Latinos and 3 of African Americans) were conducted in three community senior service organizations (two senior centers and one church). Ten semi-structured interviews were conducted to support and augment focus group data. Seventy-two community dwelling minority older adults aged 62 years and older and 10 community stakeholders participated. A community-based partnered research approach was used and two community partners participated in the analysis and interpretation of results. Standard qualitative content-analysis methods were used to identify and organize themes in domains. Focus group participants were 49% Latino and 51 o/o African American. Results included barriers: 1) mistrust, 2) fear of specimen collection/storage, 3) perceived harms, 4) competing demands, and 5) costs. Older Latinos cited issues of language as barriers to awareness and acceptance of biomarkers. African Americans had concerns over perceived harms of biomarkers. Facilitators to acceptance of biomarkers were community engagement through church and community leaders. Older Latino and African Americans identified many barriers and facilitators to the collection and storage of biomarkers. Participants identified community-partnered recommendations to overcome barriers to the acceptance, collection, and storage of biomarkers.
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21
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Iyer SP, Jones A, Talamantes E, Barnert ES, Kanzaria HK, Detz A, Daskivich TJ, Jones L, Ryan GW, Mahajan AP. Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue. Ethn Dis 2015; 25:487-94. [PMID: 26675541 DOI: 10.18865/ed.25.4.487] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue. DESIGN Qualitative study using a community-partnered participatory research framework. SETTING Community forum breakout discussion. DISCUSSANTS Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district. MAIN OUTCOME MEASURES Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes. RESULTS Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality. CONCLUSIONS Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.
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Affiliation(s)
- Sharat P Iyer
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 2. VISN3 Mental Illness Research, Education, and Clinical Center, James J. Peters VA Medical Center, Bronx, NY ; 3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Andrea Jones
- 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles
| | - Efrain Talamantes
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles
| | - Elizabeth S Barnert
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles
| | - Hemal K Kanzaria
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles ; 7. Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles ; 8. VA Greater Los Angeles Healthcare System
| | - Alissa Detz
- 6. National Research Service Award GIM Fellowship in Primary Care & Health Services Research, University of California, Los Angeles
| | - Timothy J Daskivich
- 1. Robert Wood Johnson Foundation Clinical Scholars® at the University of California, Los Angeles
| | - Loretta Jones
- 4. Charles R. Drew University of Medicine and Science, Los Angeles ; 5. Healthy African American Families, Los Angeles
| | - Gery W Ryan
- 10. Los Angeles County Department of Health Services
| | - Anish P Mahajan
- 10. Los Angeles County Department of Health Services ; 11. Division of General Internal Medicine and Health Service Research, University of California, Los Angeles
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Peláez S, Lamontagne AJ, Collin J, Gauthier A, Grad RM, Blais L, Lavoie KL, Bacon SL, Ernst P, Guay H, McKinney ML, Ducharme FM. Patients' perspective of barriers and facilitators to taking long-term controller medication for asthma: a novel taxonomy. BMC Pulm Med 2015; 15:42. [PMID: 25907709 PMCID: PMC4429418 DOI: 10.1186/s12890-015-0044-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Although asthma morbidity can be prevented through long-term controller medication, most patients with persistent asthma do not take their daily inhaled corticosteroid. The objective of this study was to gather patients’ insights into barriers and facilitators to taking long-term daily inhaled corticosteroids as basis for future knowledge translation interventions. Methods We conducted a collective qualitative case study. We interviewed 24 adults, adolescents, or parents of children, with asthma who had received a prescription of long-term inhaled corticosteroids in the previous year. The one-hour face-to-face interviews revolved around patients’ perceptions of asthma, use of asthma medications, current self-management, prior changes in self-management, as well as patient-physician relationship. We sought barriers and facilitators to optimal asthma management. Interviews were transcribed verbatim and transcripts were analyzed using a thematic approach. Results Patients were aged 2–76 years old and 58% were female. Nine patients were followed by an asthma specialist (pulmonologist or allergist), 13 patients by family doctors or pediatricians, and two patients had no regular follow-up. Barriers and facilitators to long-term daily inhaled corticosteroids were classified into the following loci of responsibility and its corresponding domains: (1) patient (cognition; motivation, attitudes and preferences; practical implementation; and parental support); (2) patient-physician interaction (communication and patient-physician relationship); and (3) health care system (resources and services). Patients recognized that several barriers and facilitators fell within their own responsibility. They also underlined the crucial impact (positive or negative) on their adherence of the quality of patient-physician interaction and health care system accessibility. Conclusions We identified a close relationship between reported barriers and facilitators to adherence to long-term daily controller medication for asthma within three loci of responsibility. As such, patients’ adherence must be approached as a multi-level phenomenon; moreover, interventions targeting the patient, the patient-physician interaction, and the health care system are recommended. The present study offers a potential taxonomy of barriers and facilitators to adherence to long-term daily inhaled corticosteroids therapy that, once validated, may be used for planning a knowledge translation intervention and may be applicable to other chronic conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0044-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Peláez
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Alexandrine J Lamontagne
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Johanne Collin
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Annie Gauthier
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada.
| | - Roland M Grad
- Department of Family Medicine, Jewish General Hospital, Montreal, Quebec, Canada.
| | - Lucie Blais
- Department of Pharmacology, University of Montreal, Montreal, Quebec, Canada.
| | - Kim L Lavoie
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada.
| | - Simon L Bacon
- Department of Exercise Sciences, Concordia University, Montreal, Quebec, Canada.
| | - Pierre Ernst
- Department of Pulmonary Medicine, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Hélène Guay
- Institut national d'excellence en santé et en services sociaux, Quebec, Quebec, Canada.
| | - Martha L McKinney
- Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada.
| | - Francine M Ducharme
- Clinical Research and Knowledge Transfer Unit on Childhood Asthma, Research Centre, Sainte-Justine University Health Centre Montreal, Quebec, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. .,Department of Paediatrics, University of Montreal, Montreal, Quebec, Canada. .,Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada. .,Departments of Pediatrics and of Social and Preventive Medicine, Associate Director of Clinical Research, Research Centre, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Room 7939, Montreal, Quebec, H3T 1C5, Canada.
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23
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Moreno G, Morales LS, Nuñez de Jaimes F, Tseng CH, Isiordia M, Noguera C, Mangione CM. Neighborhood perceptions and health-related outcomes among Latinos with diabetes from a rural agricultural community. J Community Health 2014; 39:1077-84. [PMID: 24599665 PMCID: PMC4156928 DOI: 10.1007/s10900-014-9854-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Little is known about how neighborhood perceptions are related to diabetes outcomes among Latinos living in rural agricultural communities. Our objective was to examine the association between perceived neighborhood problems and diabetes outcomes. This is a cross-sectional survey study with medical record reviews of a random sample of 250 adult Latinos with type 2 diabetes. The predictor was a rating of patient ratings of neighborhood problems (crime, trash and litter, lighting at night, and access to exercise facilities, transportation, and supermarkets). The primary outcomes were the control of three intermediate outcomes [LDL-cholesterol (LDL-c) < 100 mg/dl, AlC < 9.0 %, and blood pressure (BP) < 140/80 mmHg], and body mass index (BMI) < 30 kg/m(2). Secondary outcomes were participation in self-care activities (physical activity, healthy eating, medication adherence, foot checks, and glucose checks). We used regression analysis and adjusted for age, gender, education, income, years with diabetes, insulin use, depressive symptoms, and co-morbidities. Forty-eight percent of patients perceived at least one neighborhood problem and out of the six problem areas, crime was most commonly perceived as a problem. Perception of neighborhood problems was independently associated with not having a BP < 140/80 [Adjusted odds ratio (AOR) = 0.45; 95 % CI 0.22, 0.92], and BMI < 30 (AOR = 0.43; 95 % CI 0.24, 0.77), after controlling for covariates. Receipt of recommended processes of care was not associated with perception of neighborhood. Perception of neighborhood problems among low-income rural Latinos with diabetes was independently associated with a higher BMI and BP.
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Affiliation(s)
- Gerardo Moreno
- Department of Family Medicine, UCLA, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA, 90024, USA,
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Lazarus L, Shaw A, LeBlanc S, Martin A, Marshall Z, Weersink K, Lin D, Mandryk K, Tyndall MW. Establishing a community-based participatory research partnership among people who use drugs in Ottawa: the PROUD cohort study. Harm Reduct J 2014; 11:26. [PMID: 25307356 PMCID: PMC4203893 DOI: 10.1186/1477-7517-11-26] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/22/2014] [Indexed: 11/12/2022] Open
Abstract
Background Grounded in a community-based participatory research (CBPR) framework, the PROUD (Participatory Research in Ottawa: Understanding Drugs) Study aims to better understand HIV risk and prevalence among people who use drugs in Ottawa, Ontario. The purpose of this paper is to describe the establishment of the PROUD research partnership. Methods PROUD relies on peers’ expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project. A Community Advisory Committee (CAC), comprised of eight people with lived experience, three allies and three ex-officio members, has been meeting since May 2012 to oversee all aspects of the project. Eleven medical students from the University of Ottawa were recruited to work alongside the committee. Training was provided on CBPR; HIV and harm reduction; and administering HIV point-of-care (POC) tests so that the CAC can play a key role in research design, data collection, analysis, and knowledge translation activities. Results From March-December 2013, the study enrolled 858 participants who use drugs (defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months) into a prospective cohort study. Participants completed a one-time questionnaire administered by a trained peer or medical student, who then administered an HIV POC test. Recruitment, interviews and testing occurred in both the fixed research site and various community settings across Ottawa. With consent, prospective follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences. Conclusion The PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC, the training of peers as community-based researchers, and integrated KTE throughout the research project. This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles, ensuring that this research process will promote change at the local level. The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other settings.
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Affiliation(s)
- Lisa Lazarus
- Ottawa Hospital Research Institute, 216 Murray Street, Ottawa, ON K1N 5N1, Canada.
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Martínez G, Sardiñas LM, Acosta-Perez E, Medina L, Rivera M, Pattatucci A. Capacity needs in community-based organizations for enhancing translational research in Puerto Rico. Prog Community Health Partnersh 2014; 8:53-60. [PMID: 24859102 DOI: 10.1353/cpr.2014.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In an effort to form and sustain community-academic partnerships (CAPs) to enhance clinical and translational research, an assessment of needs for selecting and implementing evidence-based programs (EBPs) was conducted among a group of community-based organizations (CBOs) throughout Puerto Rico. METHODS The survey was based on an instrument developed by the Cancer Prevention and Control Research Network. It assessed specific service information, program selection/implementation processes, knowledge and perception of EBPs, funding venues, evaluation processes, and capacity and training needs. Recruitment consisted of contacting 100 nonprofit organizations in Puerto Rico that work or address specific health areas, namely, cancer, neurological disorders, HIV, and cardiovascular health. RESULTS The survey revealed wide variability in understanding what constitutes an EBP. Training needs for building a productive translational research process also were identified. Prominent among these were securing funding for ongoing operations, utilizing data for decision making, developing collaborations, managing information, conducting community needs assessments, and program evaluation. CONCLUSIONS These findings point to important implications for promoting community-campus partnerships for advancing clinical and translational research.
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Tapp H, White L, Steuerwald M, Dulin M. Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care. J Comp Eff Res 2014; 2:405-19. [PMID: 24236682 DOI: 10.2217/cer.13.45] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.
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Affiliation(s)
- Hazel Tapp
- Carolinas HealthCare System, PO Box 32861, NC, USA
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Physical Activity, Physical Performance, and Biological Markers of Health among Sedentary Older Latinos. Curr Gerontol Geriatr Res 2014; 2014:535071. [PMID: 25136359 PMCID: PMC4119654 DOI: 10.1155/2014/535071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/26/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Physical activity is associated with better physical health, possibly by changing biological markers of health such as waist circumference and inflammation, but these relationships are unclear and even less understood among older Latinos-a group with high rates of sedentary lifestyle. Methods. Participants were 120 sedentary older Latino adults from senior centers. Community-partnered research methods were used to recruit participants. Inflammatory (C-reactive protein) and metabolic markers of health (waist circumference, HDL-cholesterol, triglycerides, insulin, and glucose), physical activity (Yale physical activity survey), and physical performance (short physical performance NIA battery) were measured at baseline and 6-month followup. Results. Eighty percent of the sample was female. In final adjusted cross-sectional models, better physical activity indices were associated with faster gait speed (P < 0.05). In adjusted longitudinal analyses, change in self-reported physical activity level correlated inversely with change in CRP (β = -0.05; P = 0.03) and change in waist circumference (β = -0.16; P = 0.02). Biological markers of health did not mediate the relationship between physical activity and physical performance. Conclusion. In this community-partnered study, higher physical activity was associated with better physical performance in cross-sectional analyses. In longitudinal analysis, increased physical activity was associated with improvements in some metabolic and inflammatory markers of health.
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Charlebois K, Loignon C, Boudreault-Fournier A, Dupéré S, Grabovschi C. [The involvement of vulnerable people in participatory research in primary care: a literature review]. Glob Health Promot 2014; 21:38-45. [PMID: 24662011 DOI: 10.1177/1757975913517123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Malgré un vif intérêt pour la participation des patients à la gestion et à la prestation des soins de santé primaires, il n’existe aucune revue de la littérature sur le rôle des personnes vulnérables dans les projets de recherche participative menés dans le domaine des soins primaires. Une revue de la littérature de type narrative a été menée afin de combler cette lacune. L’objectif principal de cette revue a été d’évaluer le rôle des personnes vulnérables au sein de projets de recherche participative. Notre revue a recensé 26 articles et analysé 33 projets de recherche ou d’intervention en soins primaires. Elle révèle de nombreux écueils concernant l’implication des personnes vulnérables. Ces personnes ont joué un rôle varié, mais surtout modeste ou limité au sein des différents projets. Leur implication a surtout eu lieu à l’étape de la collecte des données. Peu de projets ont permis aux personnes vulnérables de prendre part à l’analyse des données ou à la diffusion des connaissances. Les tensions entre les chercheurs et les personnes vulnérables et la tendance à intégrer des acteurs organisés au sein des projets ont contribué à affaiblir le degré de participation des personnes vulnérables, et ce, à diverses étapes du processus de recherche et du développement d’intervention. Malgré tout, plusieurs retombées positives ont été identifiées, tant pour la communauté et les personnes vulnérables que pour les chercheurs. Entre autres, les projets ont permis aux chercheurs non universitaires d’acquérir de nouvelles compétences. De plus, certains projets ont favorisé la mise en place de nouveaux modèles de prestations de soins. Enfin, différents mécanismes permettant de rehausser la réciprocité entre les chercheurs et les personnes vulnérables sont proposés comme solutions pour réduire les inégalités et les tensions et, ultimement, favoriser l’implication des personnes vulnérables.
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Affiliation(s)
- Kathleen Charlebois
- Centre de recherche de l'Hôpital Charles LeMoyne, Université de Sherbrooke, Québec, Canada
| | - Christine Loignon
- Centre de recherche de l'Hôpital Charles LeMoyne, Université de Sherbrooke, Québec, Canada
| | | | - Sophie Dupéré
- Faculté des Sciences Infirmières, Université Laval, Québec, Canada
| | - Cristina Grabovschi
- Centre de recherche de l'Hôpital Charles LeMoyne, Université de Sherbrooke, Québec, Canada
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Baquet CR. A model for bidirectional community-academic engagement (CAE): overview of partnered research, capacity enhancement, systems transformation, and public trust in research. J Health Care Poor Underserved 2014; 23:1806-24. [PMID: 23698691 DOI: 10.1353/hpu.2012.0155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The University of Maryland's Office of Policy and Planning in collaboration with urban and rural community partners, planned and implemented a model for community-academic engagement (CAE) in partnered research and programs. The model addressed health disparities, cancer and tobacco-related diseases, and public trust in research. Environments have flourished that resulted in bidirectional community-academic interactions, and led to transformation of the academic environment and community capacity to identify and address health issues. This collaborative model produced: • enhanced public trust in research; and • enhanced community and Academic Health Center (AHC) capacity to address community health needs as partners. A unique feature of this model is AHC's shared grant funding with community partners serving diverse and medically underserved communities for predetermined roles in research, policy and educational programs. Over $18 million in grant funding was provided to community organizations. This paper presents an overview of this model as a case study.
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Lakes KD, Vaughan E, Pham J, Tran T, Jones M, Baker D, Swanson JM, Olshansky E. Community member and faith leader perspectives on the process of building trusting relationships between communities and researchers. Clin Transl Sci 2014; 7:20-8. [PMID: 24405695 DOI: 10.1111/cts.12136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In the first phase of this research, we conducted, audio-recorded, and transcribed seven focus groups with more than 50 English- or Spanish-speaking women of childbearing age. Qualitative analysis revealed the following themes: (1) expectation that participation would involve relationships based on trust that is built over time and impacted by cultural factors; (2) perceived characteristics of research staff that would help facilitate the development of trusting relationships; (3) perceptions about the location of the visits that may affect trust; (4) perceptions of a research study and trust for the institution conducting the study may affect trust; (5) connecting the study to larger communities, including faith communities, could affect trust and willingness to participate. In the second phase of this research, we conducted, recorded, transcribed, and analyzed interviews with leaders from diverse faith communities to explore the potential for research partnerships between researchers and faith communities. In addition to confirming themes identified in focus groups, faith leaders described an openness to research partnerships between the university and faith communities and considerations for the formation of these partnerships. Faith leaders noted the importance of finding common ground with researchers, establishing and maintaining trusting relationships, and committing to open, bidirectional communication.
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Affiliation(s)
- Kimberley D Lakes
- Orange County Vanguard Center for the National Children's Study, Department of Pediatrics, University of California, Irvine, California, USA; Institute for Clinical and Translational Science, University of California, Irvine, Irvine, California, USA
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Frierson GM, Morrow JR, Vidales A. Successful minority recruitment and adherence in physical activity Internet-based research: the WIN study. J Natl Med Assoc 2013; 104:544-54. [PMID: 23560357 DOI: 10.1016/s0027-9684(15)30221-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Researchers studying physical activity often face challenges dealing with recruitment and resources, particularly when conducting longitudinal Internet-based research. Commonly raised methodological problems such as minority recruitment, participant commitment, and participant-staff involvement are addressed through a theoretically driven recruitment and adherence protocol in The Women's Exercise Injuries: Incidence and Risk Factors (WIN) Internet-based study. OBJECTIVES The objectives of this paper were to review and suggest solutions to problems of: (1) low recruitment of diverse samples, (2) low adherence, and (3) staffing needs. METHODS We recruited 1303 community-dwelling women and followed them through a multiple-phase, longitudinal, Internet-based study. Recruitment and adherence data were analyzed through descriptive methods and logistic regressions to examine participant adherence and sociodemographic factors and predictors of who entered the long-term phase of the study. RESULTS We successfully retained 71.6% of the sample through 4 recruitment phases. Twenty-seven percent of the initially recruited sample was racial/ethnically diverse, 24% began the long-term phase, and 23% completed. Several strategies to enhance participant commitment were successfully used during the practice phase, providing a successful, low staff to participant ratio. Logistic regression indicated being married, being older, and having greater Internet skills were predictive of successfully entering the long-term phase of the study. CONCLUSIONS Recruitment and compliance protocols were successful in meeting overall and racial/ethnic enrollment and recruitment goals. The theoretically based practice phase techniques were successful in re-engaging noncompliant participants. Strategies for minority enrollment and compliance are evaluated.
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Affiliation(s)
- Georita M Frierson
- Department of Psychology, Southern Methodist University, Dallas, Texas, USA.
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Tapp H, White L, Steuerwald M, Dulin M. Use of community-based participatory research in primary care to improve healthcare outcomes and disparities in care. J Comp Eff Res 2013. [PMID: 24236682 PMCID: PMC4042315 DOI: 10.2217/cer.13.45,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Community-based participatory research (CBPR) has emerged to bridge the gap between research and primary-care practice through community engagement and social action to increase health equity. It is widely acknowledged that access to high-quality primary care services is important to the overall health of a community. Here, CBPR studies in a primary care setting are reviewed to assess the use of CBPR associated with common health problems seen in primary care such as access to care and disparities in chronic disease management across vulnerable populations. CBPR involves building relationships with local communities, determining areas of need and establishing priorities for health concerns. Studies showing improved access to care for a Hispanic population, reduced asthma symptoms and weight loss are highlighted.
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Affiliation(s)
- Hazel Tapp
- Carolinas HealthCare System, PO Box 32861, NC, USA
- Author for correspondence:
| | - Lauren White
- Carolinas HealthCare System, PO Box 32861, NC, USA
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Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis 2012; 19:244-51. [PMID: 22732044 PMCID: PMC3385991 DOI: 10.1053/j.ackd.2012.01.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 01/04/2023]
Abstract
In the United States, racial-ethnic minorities experience disproportionately high rates of ESRD, but they are substantially less likely to receive living donor kidney transplants (LDKT) compared with their majority counterparts. Minorities may encounter barriers to LDKT at several steps along the path to receiving it, including consideration, pursuit, completion of LDKT, and the post-LDKT experience. These barriers operate at different levels related to potential recipients and donors, health care providers, health system structures, and communities. In this review, we present a conceptual framework describing various barriers that minorities face along the path to receiving LDKT. We also highlight promising recent and current initiatives to address these barriers, as well as gaps in initiatives, which may guide future interventions to reduce racial-ethnic disparities in LDKT.
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Affiliation(s)
- Tanjala S. Purnell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD
| | - Yoshio N. Hall
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington
| | - L. Ebony Boulware
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Aysola J, Orav EJ, Ayanian JZ. Neighborhood Characteristics Associated With Access To Patient-Centered Medical Homes For Children. Health Aff (Millwood) 2011; 30:2080-9. [DOI: 10.1377/hlthaff.2011.0656] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jaya Aysola
- Jaya Aysola ( ) is a research fellow in the Department of Health Care Policy at Harvard Medical School and at Brigham and Women’s Hospital, in Boston, Massachusetts
| | - E. John Orav
- John Z. Ayanian (
) is a professor of medicine and health care policy at Harvard Medical School and a professor of health policy and management at the Harvard School of Public Health
| | - John Z. Ayanian
- E. John Orav is an associate professor of biostatistics at the Harvard School of Public Health and an associate professor of medicine (biostatistics) at Harvard Medical School
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Lindau ST, Makelarski JA, Chin MH, Desautels S, Johnson D, Johnson WE, Miller D, Peters S, Robinson C, Schneider J, Thicklin F, Watson NP, Wolfe M, Whitaker E. Building community-engaged health research and discovery infrastructure on the South Side of Chicago: science in service to community priorities. Prev Med 2011; 52:200-7. [PMID: 21236295 PMCID: PMC3062697 DOI: 10.1016/j.ypmed.2011.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 12/31/2010] [Accepted: 01/05/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the roles community members can and should play in, and an asset-based strategy used by Chicago's South Side Health and Vitality Studies for, building sustainable, large-scale community health research infrastructure. The Studies are a family of research efforts aiming to produce actionable knowledge to inform health policy, programming, and investments for the region. METHODS Community and university collaborators, using a consensus-based approach, developed shared theoretical perspectives, guiding principles, and a model for collaboration in 2008, which were used to inform an asset-based operational strategy. Ongoing community engagement and relationship-building support the infrastructure and research activities of the studies. RESULTS Key steps in the asset-based strategy include: 1) continuous community engagement and relationship building, 2) identifying community priorities, 3) identifying community assets, 4) leveraging assets, 5) conducting research, 6) sharing knowledge and 7) informing action. Examples of community member roles, and how these are informed by the Studies' guiding principles, are provided. CONCLUSIONS Community and university collaborators, with shared vision and principles, can effectively work together to plan innovative, large-scale community-based research that serves community needs and priorities. Sustainable, effective models are needed to realize NIH's mandate for meaningful translation of biomedical discovery into improved population health.
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Affiliation(s)
- Stacy Tessler Lindau
- The University of Chicago, Department of Ob/Gyn, Urban Health Initiative, 5841 S. Maryland Ave., MC2050 R-311, Chicago, IL 60637, USA.
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Shuval K, Pillsbury CA, Cavanaugh B, McGruder L, McKinney CM, Massey Z, Groce NE. Evaluating the impact of conflict resolution on urban children's violence-related attitudes and behaviors in New Haven, Connecticut, through a community-academic partnership. HEALTH EDUCATION RESEARCH 2010; 25:757-68. [PMID: 20444803 PMCID: PMC2936554 DOI: 10.1093/her/cyq030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 04/02/2010] [Indexed: 05/29/2023]
Abstract
Numerous schools are implementing youth violence prevention interventions aimed at enhancing conflict resolution skills without evaluating their effectiveness. Consequently, we formed a community-academic partnership between a New Haven community-based organization and Yale's School of Public Health and Prevention Research Center to examine the impact of an ongoing conflict resolution curriculum in New Haven elementary schools, which had yet to be evaluated. Throughout the 2007-08 school year, 191 children in three schools participated in a universal conflict resolution intervention. We used a quasi-experimental design to examine the impact of the intervention on participants' likelihood of violence, conflict self-efficacy, hopelessness and hostility. Univariate and multivariable analyses were utilized to evaluate the intervention. The evaluation indicates that the intervention had little positive impact on participants' violence-related attitudes and behavior. The intervention reduced hostility scores significantly in School 1 (P<0.01; Cohen's d=0.39) and hopelessness scores in School 3 (P=0.05, Cohen's d=0.52); however, the intervention decreased the conflict self-efficacy score in School 2 (P=0.04; Cohen's d=0.23) and was unable to significantly change many outcome measures. The intervention's inability to significantly change many outcome measures might be remedied by increasing the duration of the intervention, adding additional facets to the intervention and targeting high-risk children.
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Affiliation(s)
- Kerem Shuval
- Yale-Griffin Prevention Research Center, Yale University School of Medicine, Derby, CT 06418, USA.
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Downey LH, Wheat JR, Leeper JD, Florence JA, Boulger JG, Hunsaker ML. Undergraduate Rural Medical Education Program Development: Focus Group Consultation With the NRHA Rural Medical Educators Group. J Rural Health 2010; 27:230-8. [DOI: 10.1111/j.1748-0361.2010.00334.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Casale CR, Clancy CM. Commentary: Not about us without us. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1333-5. [PMID: 19881415 DOI: 10.1097/acm.0b013e3181b6afd0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Disparities in health care are pervasive, but the patterns vary substantially across the nation. Solutions to eliminate health care disparities associated with patient race, ethnicity, income, education, geography, and other factors must be customized to address the specific circumstances of each community. The urgency of addressing disparities exceeds the available evidence to do so. In this context, community-based participatory research (CBPR) offers an appealing strategy to develop the requisite evidence while improving care.Using case studies from their experience, Moreno and colleagues convey a thoughtful, realistic account of the University of California, Los Angeles Family Medicine CBPR experience focused on addressing disparities in health and health care among racial/ethnic minority immigrant populations in a Los Angeles County community. This report highlights both the potential for community transformation and the challenges encountered by medical student researchers in the quest to establish meaningful partnerships that promote and value community members' contributions to the research areas under study, with the goal of improving health outcomes and reducing health care disparities.The authors of this commentary believe that the ongoing national debate addressing the need to reform the health care system in the United States and reduce health and health care disparities for underserved populations will bring increased focus on applying the tenets of CBPR. Sustaining relevant health care services research that engages community partners, researchers, and funders is a promising model of community engagement with potential for replication and sustainability.
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