Development of a Mixed Methods Investigation of Process and Outcomes of Community-Based Participatory Research

Lessons learned in measuring patient engagement in a Canada-wide childhood disability network

BACKGROUND

The CHILD-BRIGHT Network, a pan-Canadian childhood disability research Network, is dedicated to patient-oriented research, where numerous stakeholders, including patient-partners, researchers, and clinicians are involved at different levels. The Network is committed to continuously improving the level of engagement and partnerships' impact. Measuring patient engagement is therefore important in reflecting on our practices and enhancing our approaches. We aimed to measure patient engagement longitudinally and explore in greater depth the perceived benefits, barriers and facilitators, and overall satisfaction with patient engagement, from the perspectives of the different stakeholders.

METHODS

Patient engagement was measured using online surveys. In a longitudinal study design over a 3-years period (2018-2020) the Community-Based Participatory Research (CBPR) questionnaire was used. To enrich our understanding of patient engagement in Year 3, we employed the Public and Patient Engagement Evaluation Tool (PPEET) in a cross-sectional, convergent parallel mixed-method study design. Descriptive statistics and a thematic-based approach were used for data analysis.

RESULTS

The CBPR questionnaire was completed by n = 167 (61.4% response rate), n = 92 (30.2% response rate), and n = 62 (14.2% response rate) Network members in Years 1, 2, and 3, respectively. Ninety-five (n = 95, 21.8% response rate) members completed the PPEET in Year 3. CBPR findings demonstrate a stable and high satisfaction level with patient engagement over time, where 94%, 86%, and 94% of stakeholders indicated that the project is a "true partnership" in Years 1, 2, and 3, respectively. In Years 2 and 3, we noted an improvement in patient-partners' comfort level in sharing their views and perspectives (92% and 91% vs. 74%). An increase in critical reflective trust (i.e., allowing for discussing and resolving mistakes) from Year 1 to 3 was found, both from the perspectives of patient-partners (51-65%) and researchers (48-75%). Using the PPEET, patient engagement factors (i.e., communications and supports for participation, ability to share views and perspectives) and impact were highly rated by most (80-100%) respondents. PPEET's qualitative responses revealed several patient engagement advantages (e.g., increased projects' relevance, enhanced knowledge translation), barriers (e.g., group homogeneity), facilitators (e.g., optimal communication strategies), and solutions to further improve patient engagement (e.g., provide clarity on goals).

CONCLUSION

Our 3-years patient engagement evaluation journey demonstrated a consistent and high level of satisfaction with patient engagement within the Network and identified advantages, barriers, facilitators, and potential solutions. Improvements were observed in members' comfort in sharing their views and perspectives, along with an increase in critical reflective trust. These findings underscore the Network's commitment to enhancing patient engagement and provide valuable insights for continued improvement and optimization of collaborative efforts.

Development and Feasibility of a Group Tele-Exercise Program for Individuals With Spinal Cord Injury

BACKGROUND AND PURPOSE

More than 50% of individuals with spinal cord injury (SCI) report no regular exercise due to numerous barriers to participation. Tele-exercise services offer viable solutions to reduce barriers. However, limited evidence for SCI-specific tele-exercise programs is available. The purpose of this study was to evaluate the feasibility of a synchronous group tele-exercise program designed for individuals with SCI.

METHODS

Explanatory sequential mixed-methods design assessed feasibility of a synchronous 2-month biweekly group tele-exercise program for individuals with SCI. Numeric measures of feasibility were first collected (recruitment rate, sample features, retention, attendance), followed by postprogram interviews with participants. Thematic analysis of experiential feedback elaborated on numeric findings.

RESULTS

Eleven volunteers (ages = 49.5 ± 16.7 years) with SCI (range: 2.7-33.0 years) enrolled within 2 weeks of recruitment initiation. Retention was 100% retention at program completion. Median number of live classes attended per participant was 10 (62.5%). Participants described that attendance and satisfaction were facilitated by program-specific features including coinstruction by instructors with SCI-specific knowledge and lived experience, as well as group structure. Participants reported increased exercise knowledge, confidence, and motivation.

DISCUSSION AND CONCLUSIONS

This study demonstrated feasibility of a synchronous group tele-exercise class for individuals with SCI. Key features facilitating participation include class length, frequency, coleadership by individuals familiar with SCI and exercise instruction, and group motivation. These findings begin to examine a viable tele-service strategy that could be employed as a bridge among rehabilitation specialists, community fitness instructors, and clients with SCI to increase physical activity access and behavior.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A442 ).

Developing relevant assessments of community-engaged research partnerships: A community-based participatory approach to evaluating clinical and health research study teams

Background/Objective

In 2017, the Michigan Institute for Clinical and Health Research (MICHR) and community partners in Flint, Michigan collaborated to launch a research funding program and evaluate the dynamics of those research partnerships receiving funding. While validated assessments for community-engaged research (CEnR) partnerships were available, the study team found none sufficiently relevant to conducting CEnR in the context of the work. MICHR faculty and staff along with community partners living and working in Flint used a community-based participatory research (CBPR) approach to develop and administer a locally relevant assessment of CEnR partnerships that were active in Flint in 2019 and 2021.

Methods

Surveys were administered each year to over a dozen partnerships funded by MICHR to evaluate how community and academic partners assessed the dynamics and impact of their study teams over time.

Results

The results suggest that partners believed that their partnerships were engaging and highly impactful. Although many substantive differences between community and academic partners' perceptions over time were identified, the most notable regarded the financial management of the partnerships.

Conclusion

This work contributes to the field of translational science by evaluating how the financial management of community-engaged health research partnerships in a locally relevant context of Flint can be associated with these teams' scientific productivity and impact with national implications for CEnR. This work presents evaluation methods which can be used by clinical and translational research centers that strive to implement and measure their use of CBPR approaches.

Patient Power and Empowerment: Mitigating Elements of Valuable Patient Participation in Healthcare Collaboratives

During the last decade, the public healthcare sector has had to deal with increased competition, a growing influence of patient associations, and a necessity to deliver health services more efficiently and effectively. Despite recognising the patient participant's role as a critical stakeholder in value creation, there is a limited body of research on the influence and power of patient participants. This article focuses on regional health improvement collaboratives that aim to develop coordinated, multi-stakeholder solutions to their healthcare cost and quality problems. They meet regularly and include health professionals, health insurance providers, and patient participants. In this article, we explore the relationships between these stakeholders and patient participants' interpersonal dimensions regarding empowerment and valuable collaboration. Data were collected through stakeholder observations during meetings of three regional health improvement collaboratives, as well as through semi-structured interviews with the patient participants involved in these cases. Results show that patient participants can be empowered on a personal level. However, this does not imply that patient participants are empowered within the group dynamics. Interpersonal relationships constitute a crucial hidden aspect of building trust. More dialogue and inquiry are needed to examine how patient engagement is enacted and positioned within healthcare collaboratives.

Application of an Implementation Framework Using Mixed Methods in Preschool Settings

Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers (n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes (r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.

Examining the influence of group diversity on the functioning of community-based participatory research partnerships: A mixed methods study

Public health has endorsed the use of community-based participatory research (CBPR) to address health inequities involving diverse and marginalized communities. However, few studies have examined how group diversity among members of CBPR partnerships influenced how well the partnerships achieve their goals of addressing health inequities through equitable collaboration. We conducted secondary, convergent, mixed methods analysis to (1) evaluate the association between group diversity and participatory decision-making within CBPR partnerships, and (2) identify the perceived characteristics, benefits, and challenges of group diversity within CBPR partnerships. Using data from a cross-site study of federally funded CBPR partnerships, we analyzed and integrated data from surveys of 163 partnerships (n = 448 partners) and seven in-depth case study interviews (n = 55 partners). Quantitatively, none of the measured characteristics of group diversity was associated with participatory decision-making within the partnerships. Qualitatively, we found that partnerships mainly benefited from membership differences in functional characteristics (e.g., skillset) but faced challenges from membership differences in sociocultural characteristics (e.g., gender and race). The integrated findings suggest the need to further understand how emergent group characteristics and how practices that engage in group diversity contribute to collective functioning of the partnerships. Attention to this area can help promote health equity achievements of CBPR partnerships.

Conceptualizing the Carrying Function of Community Advisory Boards

Community Advisory Boards (CABs) often, “carry” important ideas and concepts for the larger organization of which they are a part. The word “carry” in this context, means that a person or group expresses verbal and nonverbal messages that inform others of what the institution acknowledges, and also what it cannot bear to feel or talk about. These expressions may include attitudes and expectations, values, risks, or disowned features and qualities. A group can contain, “carry,” and express formal, informal, and unconscious issues for a department or system. In this article, we situate our theoretical underpinning of this carrying function by relying on a number of literatures: identified patient, splitting and projection, parallel process, and container and contained. Specifying and examining the dynamics of what CABs carry for an institution can prevent common pitfalls for these groups, such as mistrust, feelings of disrespect, lack of productivity, and thwarted expectations.

Increasing research capacity in community organizations: Findings from the Community Research Scholars Initiative

Increasing research capacity in community-based organizations (CBOs) can equip the organizations to be more equal partners in academic/community partnerships and can help them be more accountable to their clients and funders. In this study, we report on findings from four years of data collected from the Community Research Scholars Initiative (CRSI) in Cleveland, Ohio. CRSI provided intensive research training over two years to two cohorts (N = 9) of frontline workers ("Scholars") from CBOs focused on health disparities. Scholars completed one year of didactic training and one year of mentoring to complete a research project based at their organization. Findings from surveys, focus groups with Scholars, and supervisor interviews indicated changes in Scholars' knowledge, confidence, and comfort with research concepts and skills. Scholars also demonstrated greater confidence in interacting with academic researchers, enhanced networks and career opportunities, and increased capacity for conducting community-based research. Scholar and organization engagement with community-based research was maintained after the program's end through a community-based research network (CBRN). Findings suggest that the intensive training program for community members with a broad curriculum, mentoring, and strong support helped changed how CBOs think about data and research and demonstrate the impact of their work.

Psychologists as leaders in equitable science: Applications of antiracism and community participatory strategies in a pediatric behavioral medicine clinical trial

Psychologists have an ethical responsibility to advance health equity and can play a significant role in improving health care experiences for families racialized as Black, including those with sickle cell disease (SCD), a group of genetic blood disorders primarily affecting communities of color. Parents of children with SCD report experiences of stigma and discrimination due to racism in the health care system. The current commentary describes the application of antiracism and participatory strategies to the research design, implementation, and dissemination of a behavioral medicine clinical trial (Engage-HU; NCT03442114) of shared decision-making (SDM) for pediatric patients with SCD, including (a) the development of a research question to promote justice for racialized groups; (b) a focus on "redressing imbalances" through SDM and a multidisciplinary, inclusive research team led by a Black psychologist; (c) community participatory approaches through the integration of stakeholder feedback across the study; and (d) centering context by attending to structural realities in response to the COVID-19 and racism pandemics. With attention to the fact that most primary caregivers of children with SCD are Black women, an intersectionality lens was applied. Implications and considerations for psychologists working to advance health equity in medical settings are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Bay Area Muslim mental health community advisory board: evaluation of a community based participatory approach

AIMS

The aim of this paper is to present a novel case for the formation, operation and evaluation of a community advisory aboard comprised of Muslims residing in the San Francisco Bay Area, California that utilised a community based participatory approach to address local Muslim mental health needs. The CAB was recruited in partnership with the Muslim Community Association (MCA), one of the largest Islamic centres in the San Franscisco Bay Area. In addition to describing the development of the CAB, the authors present the findings of the evaluation and synthesis of best processes based on CAB members' feedback.

METHODS

To evaluate the perceived community advisory board members' perceptions of their roles and elicit feedback on how to enhance the relationship between the university team and the CAB, an evaluation was conducted by an independent team who was not part of the research process. Data was collected using anonymous individual surveys and small group open discussions that were conducted over three evaluation meetings. The evaluation utilised mixed method data collection strategies using questions from Schulz et al. (, Evaluation and Program Planning 26, 249-262), an instrument for evaluating dimensions of group dynamics within CBPR partnerships.

RESULTS

Results of the evaluation within the sphere of CAB operation indicated that CAB members found the greatest satisfaction from their contributions through direct participation in the research activities that were conducted by the university-CAB team. The collective responses indicated that most CAB members were satisfied with trust built between the university-CAB team and the diversity represented in the members of the board. However, given that the Bay Area is home to a very diverse Muslim community, challenges in recruiting representatives that account for all possible self-identifying groups was reported by the CAB with recommendations to recruit religious leaders. Recommendations also included eliciting funds for potential financial compensation for CAB members.

CONCLUSIONS

The Stanford-San Francisco Bay Area CAB demonstrated that empowering community members through direct participation, creating channels and safe spaces for feedback help create community rooted research that carry the true voices of marginalised communities and reflects their evolving needs.

Being a Black Mother Living with HIV Is a “Whole Story”: Implications for Intersectionality Approach

While African, Caribbean, and Black (ACB) mothers living with HIV in Canada are required to follow public health guidelines by exclusively formula feeding their infants, they also face cultural expectations from peers and family members to breastfeed. They face multiple challenges because of their race, ethnicity, gender, class, and geographical location, among other factors. Previously published studies on this subject did not analyze how the intersectionality of these factors impacts Black mothers’ infant feeding experiences. In this article, we discuss the infant feeding practices of Black mothers living with HIV in Ottawa (Canada). We followed a qualitative methods research design that utilized intersectionality and a community-based participatory research approach. We used the intersectionality framework as a lens to analyze the complex mesh of determinants influencing motherhood experiences of ACB women living with HIV. Being a Black/ACB mother while living with HIV is a “whole story” permeated with cutting-across issues such as race, class, gender, socio-political, and cultural contexts. These issues are interwoven and often difficult to unravel. Multiple layers of structural determinants of Black/ACB women’s HIV vulnerability and health are described. Intersectionality is important for an in-depth understanding of societal power dynamics and their impact on women’s health inequities.

Development of a multidimensional culturally and socially inclusive measure of factors that support resilience: Child Resilience Questionnaire-Child report (CRQ-C)-a community-based participatory research and psychometric testing study in Australia

OBJECTIVE

Development and testing of a comprehensive and social and culturally inclusive child-report measure of resilience factors supporting positive outcomes in the face of adversity.

DESIGN

The measure is based on a socioecological model of resilience and was developed and revised using community-based participatory research methods with Aboriginal and refugee background communities. Pilot testing and validation of the child-report version (Child Resilience Questionnaire-Child report (CRQ- C)) is described in this paper.

SETTING

Australia.

PARTICIPANTS

Children aged 7-12 years from culturally and socially diverse backgrounds completed the CRQ- C in the pilot (n=387) and validation study (n=775). Families recruited via hospital clinics, Aboriginal and refugee background communities and nested follow-up of participants in an existing cohort study.

ANALYSIS

The factor structure and construct validity of CRQ-C scales were assessed using exploratory and confirmatory factor analyses. Preliminary assessment of criterion validity was conducted usinghe Strengths and Difficulties Questionnaire (SDQ). Internal consistency of final scales was assessed using Cronbach's alpha.

RESULTS

Conceptually developed CRQ-C was over inclusive of resilience factors and items. Exploratory factor analyses and confirmatory factor analyses supported 10 subscales reflecting personal resilience factors (positive self/future, managing emotions) and connectedness to family, school and culture. Excellent scale reliability (α=0.7-0.9) for all but one scale (Friends, α=0.6). Significant negative correlation between CRQ-C and SDQ total difficulty score supporting criterion validity (r_s=-0.317, p<0.001).

CONCLUSION

The CRQ-C is a new culturally and socially inclusive self-report measure of resilience factors in childhood, with demonstrated content, construct and scale reliability. Further testing of criterion validity required. Availability of child and parent report CRQ supports broad applications in clinical, research and intervention work. Socially inclusive and culturally appropriate tools are fundamental to create the evidence needed to assess and guide intervention efforts.

Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Development and validation of a multidimensional, culturally and socially inclusive Child Resilience Questionnaire (parent/caregiver report) to measure factors that support resilience: a community-based participatory research and psychometric testing study in Australia

OBJECTIVE

Develop a comprehensive socially inclusive measure to assess child resilience factors.

DESIGN

A socioecological model of resilience, community-based participatory research methods and two rounds of psychometric testing created the Child Resilience Questionnaire (parent/caregiver report, child report, school report). The parent/caregiver report (CRQ-P/C) is the focus of this paper.

SETTING

Australia.

PARTICIPANTS

Culturally and socially diverse parents/caregivers of children aged 5-12 years completed the CRQ-P/C in the pilot (n=489) and validation study (n=1114). Recruitment via a large tertiary hospital's outpatient clinics, Aboriginal and refugee background communities (Aboriginal and bicultural researchers networks) and nested follow-up of mothers in a pregnancy cohort and a cohort of Aboriginal families.

ANALYSIS

Exploratory and confirmatory factor analyses conducted to assess the structure and construct validity of CRQ-P/C subscales. Cronbach's alpha used to assess internal consistency of subscales. Criterion validity assessed with the Strengths and Difficulties Questionnaire (SDQ) parent report.

RESULTS

Conceptually developed CRQ comprised 169 items in 19 subscales across five socioecological domains (self, family, friends, school and community). Two rounds of psychometric revision and community consultations created a CRQ-P/C with 43 items in 11 scales: self (positive self, positive future, managing emotions), family (connectedness, guidance, basic needs), school (teacher support, engagement, friends) and culture (connectedness, language). Excellent scale reliability (α=0.7-0.9), except basic needs scale (α=0.61) (where a highly endorsed item was retained for conceptual integrity). Criterion validity was supported: scales had low to moderate negative correlations with SDQ total difficulty score (R_s= -0.2/-0.5. p<0.001); children with emotion/behavioural difficulties had lower CRQ-P/C scores (β=-14.5, 95% CI -17.5 to -11.6, adjusted for gender).

CONCLUSION

The CRQ-P/C is a new multidomain measure of factors supporting resilience in children. It has good psychometric properties and will have broad applications in clinical, educational and research settings. The tool also adds to the few culturally competent measures relevant to Aboriginal and refugee background communities.

Engaging Members of a Northern Plains Indian Reservation to Promote Community Responsive Health Care

This article describes a project to engage community members and to determine how a school nurse-community partnership could improve healthcare equity within an American Indian community. The purpose of this community-building project was to establish a relationship among school nurse practitioners, children, and their community in a Northern Plains Indian reservation using a Community-Based Participatory Research (CBPR) model. CBPR requires a partnership between community members and school nurses in prioritizing community needs, developing an appropriate intervention, and engaging the community throughout the intervention project process. Partnering with teachers and the community, we engaged 78 students in a year-long project in which children depicted their perceptions of well-being and wellness through bimonthly art activities. This project laid the groundwork for a strong community partnership with school nurses in addressing the well-being of children and the further exploration of community needs.

Conceptualising, operationalising, and measuring trust in participatory health research networks: a scoping review

BACKGROUND

There are many described benefits of community-based participatory research (CBPR), such as increased relevance of research for those who must act on its findings. This has prompted researchers to better understand how CBPR functions to achieve these benefits through building sustainable research partnerships. Several studies have identified "trust" as a key mechanism to achieve sustainable partnerships, which themselves constitute social networks. Although existing literature discusses trust and CBPR, or trust and social networks, preliminary searches reveal that none link all three concepts of trust, CBPR, and social networks. Thus, we present our scoping review to systematically review and synthesize the literature exploring how trust is conceptualised, operationalised, and measured in CBPR and social networks.

METHODS

This review follows the guidance and framework of Peters et al. which is underpinned by the widely used framework of Levac and colleagues. Levac and colleagues provided enhancements to the methodological framework of Arksey and O'Malley. We explored several electronic databases including Scopus, Medline, PubMed, Web of Science, CINAHL, Cochrane Library, Google Scholar, and PsychINFO. A search strategy was identified and agreed upon by the team in conjunction with a research librarian. Two independent reviewers screened articles by title and abstract, then by full-text based on pre-determined exclusion/inclusion criteria. A third reviewer arbitrated discrepancies regarding inclusions/exclusions. A thematic analysis was then conducted to identify relevant themes and sub-themes.

RESULTS

Based on the 26 extracted references, several key themes and sub-themes were identified which highlighted the complexity and multidimensionality of trust as a concept. Our analysis revealed an additional emergent category that highlighted another important dimension of trust-outcomes pertaining to trust. Further, variation within how the studies conceptualised, operationalised, and measured trust was illuminated. Finally, the multidimensionality of trust provided important insight into how trust operates as a context, mechanism, and outcome.

CONCLUSIONS

Findings provide support for future research to incorporate trust as a lens to explore the social-relational aspects of partnerships and the scope to develop interventions to support trust in partnerships.

Moving Food Assistance into the Digital Age: A Scoping Review

One of the most basic needs globally, food assistance refers to the multitude of programs, both governmental and non-governmental, to improve food access and consumption by food-insecure individuals and families. Despite the importance of digital and mobile Health (mHealth) strategies in food insecurity contexts, little is known about their specific use in food assistance programs. Therefore, the purpose of this study was to address that gap by conducting a scoping review of the literature. Keywords were defined within the concepts of food assistance and digital technology. The search included relevant peer-reviewed and grey literature from 2011 to 2021. Excluded articles related to agriculture and non-digital strategies. PRISMA guidelines were followed to perform a partnered, two-round scoping literature review. The final synthesis included 39 studies of which most (84.6%) were from the last five years and United States-based (93.2%). The top three types of articles or studies included text and opinion, qualitative research, and website, application, or model development (17.9%). The top three types of digital tools were websites (56.4%), smartphone applications (20.5%), and chatbots (5.1%). Nineteen digital features were identified as desirable. Most tools included just one or two features. The most popular feature to include was online shopping (n = 14), followed by inventory management, and client tracking. Digital tools for individual food assistance represent an opportunity for equitable and stable access to programs that can enhance or replace in-person services. While this review identified 39 tools, all are in early development and/or implementation stages. Review findings highlight an overall lack of these tools, an absence of user-centered design in their development, and a critical need for research on their effectiveness globally. Further analysis and testing of current digital tool usage and interventions examining the health and food security impacts of such tools should be explored in future studies, including in the context of pandemics, where digital tools allow for help from a distance.

Advancing Antiracism in Community-Based Research Practices in Early Childhood and Family Mental Health

Structural racism-the ways that institutional policies, practices, and other norms operate to create and sustain race-based inequities¹-has historically been foundational to the operations of academic medical centers and research institutions. Since its inception, academic medicine has depended on the exploitation of vulnerable communities to achieve medical, educational, and research goals.² Research practices have long ignored or taken advantage of the individuals purportedly benefiting from the research, a dynamic most manifestly true for Black, Indigenous, and People of Color (BIPOC) communities in the United States. Reflecting current practices in racial justice work, we intentionally use the term "BIPOC" to highlight shared experiences within racially and ethnically minoritized communities, given the history of White supremacy in the United States. We acknowledge limitations of this term, which collapses myriad unique communities and histories into one construct. Specifically, child and adolescent psychiatry has historically been driven by Eurocentric approaches, paradigms, and methodology. These nonparticipatory dominant research practices have contributed to a lack of culturally responsive interventions for BIPOC communities, a paucity of evidence-based practices with demonstrated effectiveness within BIPOC communities, and disparities in access and quality of care.³ Mental health research involving BIPOC communities has been replete with exploitation and inequality.².

Addressing Youth-Focused Research Questions in a Community Context: Collecting and Integrating Mixed Methods Data at Multiple Ecological Levels with the PhotoStories Project

Research seeking to understand and improve social conditions for marginalized youth would benefit from merging complex mixed methods research designs emphasizing multilevel data and participatory-social justice principles. We contribute to mixed methods research by introducing a multilevel, participatory-social justice mixed methods design that accomplishes this task and by illustrating its real-world application via PhotoStories, a multistage study aimed at understanding youths' community-based experiences and emotional well-being. During the project's three phases (preparation, training, and dissemination) we obtained and integrated quantitative and qualitative data at multiple ecological levels. Additionally, we examined youth perceptions about their participation, an important outcome given our participatory-social justice focus. We also provide lessons learned and recommendations for investigators seeking to use similar approaches for youth-focused research.

Using a Community-Based Participatory Mixed Methods Research Approach to Develop, Evaluate, and Refine a Nutrition Intervention to Replace Sugary Drinks with Filtered Tap Water among Predominantly Central-American Immigrant Families with Infants and Toddlers: The Water Up @Home Pilot Evaluation Study

Descriptions of the implementation of community-based participatory mixed-methods research (CBPMMR) in all phases of the engagement approach are limited. This manuscript describes the explicit integration of mixed-methods in four stages of CBPR: (1) connecting and diagnosing, (2) prescribing-implementing, (3) evaluating, and (4) disseminating and refining an intervention that aimed to motivate Latino parents (predominantly Central American in the US) of infants and toddlers to replace sugary drinks with filtered tap water. CBPMMR allowed for co-learning that led to the identification of preliminary behavioral outcomes, insights into potential mechanisms of behavior change, and revisions to the intervention design, implementation and evaluation.

Community-University Partnership in Water Education and Linkage Process. Study Case: Manglaralto, Santa Elena, Ecuador

Universities have the mission to serve society by being pragmatic, diverse, and multidisciplinary. Similar to society in general, these centers have a common challenge: finding a way to articulate projects that favor the demands and needs of vulnerable rural sectors. In this case, the community-university partnership is based on the interaction of the Manglaralto population, represented by the Junta Administradora del Agua Potable Regional de Manglaralto and the Escuela Superior Politécnica del Litoral (ESPOL), both from Ecuador. Specifically, it is based on a collaborative relationship since 2005, through the Centro de Investigación y Proyectos Aplicados a Ciencias de la Tierra (CIPAT) of the ESPOL. This work aims to evaluate the community-university partnership through the results obtained in community work projects. In addition, it describes the resolution of problems reached on the sustainability of water resources in the parish of Manglaralto (Ecuador). The methodology was based on (i) the description of the existing community-university interaction framework, (ii) the analysis of the community projects that CIPAT developed in the period 2017–2020, and finally, (iii) the evaluation of the impact of the actions carried out on the sustainability of the coastal aquifer. The community-university partnership has generated relevant information (e.g., water reserves, extraction processes, aquifer recharge, and care of the resource) for the community and has allowed for the strengthening and transmitting of knowledge in different specialties (education, culture, and environment). In the 2017–2020 period, four community projects were carried out with students, researchers, and the inhabitants of the rural area of Manglaralto. These projects allowed wells for water extraction and engineering structures such as dikes and green filters that help the use and recharge the aquifer. In addition, the initiatives carried out made it possible to inform the population of the importance of the sustainable exploitation of water resources. In general, this work made it possible to identify a natural laboratory of human interaction in which the results obtained are based on the collaboration and contribution of all the participating actors.

Enhancing racial equity in LIS research by increasing representation of BIPOC

The escalation of discourse on racial injustice prompts novel ideas to address the persistent lack of racial equity in LIS research. The underrepresentation of BIPOC perspectives contributes to the inequity. Applying the Community Based Participatory Research (CBPR) approach meaningfully engages BIPOC to help guide LIS investigations that identify evolving needs and concerns, such as how systematic racism may contribute to social justice issues like environmental and health inequity. Engaging with BIPOC, using the CBPR approach, can help address racial equity in LIS because it will result in increased racial representation which enables incorporation of the perspectives and priorities of BIPOC. This shift to greater engagement is imperative to respond to escalating attention to social injustice and ensure that these central issues are adequately reflected in LIS research. The discipline is positioned to help detail the drivers and implications of inequity and develop ways to address them. We underscore the importance of working across research disciplines by describing our CBPR experience engaging with BIPOC in LIS research. We highlight the perspectives of community partners who have over two decades of experience with community-based LIS research. We offer lessons learned to LIS researchers by describing the factors that make these initiatives successful and those which contribute to setbacks.

A Contribution to Measure Partnership Trust in Community-Based Participatory Research and Interventions With Latinx Communities in the United States

Given the growing diversity in the United States, responsiveness to the needs of diverse communities is paramount. Latinx communities in the United States often state mistrust in outside institutions because of adverse experiences. Community-based participatory research (CBPR) is considered a trust-building process and is one approach to understand disparities. However, the conceptualization and evaluation of trust as a CBPR outcome are understudied. This article summarizes a community-engaged research process conducted for the cultural and linguistic refinement of a partnership trust survey tool to assess partnership trust as an outcome of CBPR (CBPR-PTS), by using Perinatal Awareness for Successful Outcomes (PASOs) as a case study and cross-cultural cognitive interviewing (CCCI) methodology. The participants were 21 diverse stakeholders of PASOs, a community-based health organization that serves the Latinx population in South Carolina. A modified version of the multidimensional measure of trust model informed instrument development. The team analyzed the CCCI data using compiling informal analysis to identify which survey items' wordings must be changed or adapted based on the participants' accounts. Sixteen of 28 questions subjected to CCCI required modifications due to translation errors, culturally specific errors, or general cognitive problems. The new survey instrument has 19 scales and 195 items categorized into nine dimensions of the modified multidimensional measure of trust model. CCCI was a useful tool to address the cross-cultural understanding issues of the CBPR-PTS. Measurement instruments should be able to capture the socioeconomic, cultural, and geographic/environmental variability of community stakeholders to help understand the diversity of the comprehension and views of the communities involved in disparities' reduction efforts.

Social participation in science: Perspectives of Spanish civil society organizations

There is a general trend toward more active, broader, and more inclusive participation of different stakeholders in science. Civil society organizations' inclusion in the scientific process is being promoted. However, there are few attempts to understand the role of civil society organizations in research. This study is based on the analysis of 31 semi-structured interviews with Spanish civil society organization managers and representatives. Our main results regarding the current relationship between civil society organizations and the research system are (a) civil society organizations mainly participate in science within one single research moment and they are unaware of their potential. (b) We identify a lack of resources, mutual knowledge (among civil society organizations and academia), and capabilities as barriers for civil society organizations' participation.

Personal Outcomes in Community-based Participatory Research Partnerships: A Cross-site Mixed Methods Study

Community-based participatory research (CBPR) has been embraced by diverse populations to address health inequities within their communities. CBPR has been shown to produce favorable health outcomes, but little is known about personal outcomes (e.g., individual growth and capacities) resulting from the direct involvement in a CBPR partnership. We empirically examine which CBPR partnerships' processes and practices are associated with personal outcomes. We hypothesize that higher levels of collaborative approaches and adherence to CBPR principles and practices would be associated with personal outcomes. Based on a national cross-site CBPR study, Research for Improved Health, we utilized mixed-method data from a comprehensive community-engagement survey (N = 450) and seven in-depth case studies to explore the hypothesized relationships. Our multivariate mixed-effects model revealed the importance of various partnering practices. Relationship dynamics emerged as key predictors including the following: respect in the partnership, voice and influence in decision-making among partners, and stewardship. Qualitative findings highlighted individual, partnership, and community-level impacts, within and beyond the partnership. Our findings have implications for CBPR best practices and highlight the potential role of personal outcomes for partnerships' sustainability, long-term outcomes, and health equity research.

Dissemination of an American Indian Culturally Centered Community-Based Participatory Research Family Listening Program: Implications for Global Indigenous Well-Being

We introduce a culture-centered indigenous program called the Family Listening Program (FLP), which was developed through a long-standing community-based participatory research (CBPR) partnership involving tribal research teams (TRTs) from three American Indian communities (Apache, Navajo, and Pueblo) with the University of New Mexico’s Center for Participatory Research (UNM-CPR). This paper provides background information on the TRT/UNM-CPR multi-generational FLP intervention funded by the National Institute on Drug Abuse and how it is poised to take the next steps of dissemination and implementation (D&I). In preparing for the next steps, the TRT/UNM-CPR team piloted two FLP dissemination activities, first at the state-level and then nationally; this paper describes these activities. Based on the learnings from the pilot dissemination, the TRT/UNM-CPR team developed an innovative D&I model by integrating a community-based participatory research culture-centered science (CBPR-CCS) approach with the Interactive Systems Framework (ISF) to examine the uptake, cultural acceptance, and sustainability of the FLP as an evidence-based indigenous family program.

Critical reflection for researcher-community partnership effectiveness: the He Pikinga Waiora process evaluation tool guiding the implementation of chronic condition interventions in Indigenous communities

Critically reflecting on researcher-community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research-community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege.

Measurement of parental executive function in early childhood settings: Instrument reliability and validity in community-led research projects

A growing number of early childhood (EC) parenting programs target adult executive function (EF) to build responsive parenting behaviors and to promote positive child development. Although measurement of EF is well understood in academic research, little work has examined EF measurement in community settings. The present study examined psychometric properties of the Behavior Rating Inventory of Executive Function-Adult Version among 203 parents whose children were enrolled in EC programs serving under-resourced communities. We calculated Cronbach's α and mean-item correlations to test internal consistency reliability. To test factor structure, we conducted exploratory factor analysis and confirmatory factor analyses. Results suggest adequate internal consistency and that factor structures, beyond the original proposed, are appropriate for our community sample. Together, findings indicate that self-report measures of adult EF may perform differently for families experiencing adversity, raising questions about the acceptability of clinical EF tools in in underserved communities.

Seeking connection: a mixed methods study of mental well-being and community volunteerism among international migrants in Japan

Background

International migration is a stressful process for which non-Western nations are a growing destination. However, little attention has been paid to the psychological well-being of international residents or their local integration in such settings. Prosocial behavior, like volunteering in one’s local community, has been demonstrated to improve mental health in native populations. Volunteerism may be a mental health promotion strategy applicable to non-native migrants as well. In order to assess such a hypothesis, this study investigated the mental well-being of international migrants living in Tokyo, Japan, who did or did not participate in formal volunteering.

Methods

This convergent mixed-methods study assessed mental well-being with the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and qualitative follow-up interviews. Migrants who contributed their time to structured volunteering roles (formal volunteers, n = 150) were recruited from local non-profit organizations. Migrants who did not formally volunteer (n = 150) were recruited from social media sites. In parallel, a nested participant sample from both groups (n = 20) were interviewed about their satisfaction with life in Tokyo.

Results

After adjusting for sociodemographic characteristics, volunteering was not associated with higher mental well-being score (p = 0.215), but instead, not feeling isolated (p = 0.008), feeling connected to Japan (p = 0.001) and employment satisfaction (p < 0.001) were significantly associated with mental well-being. Follow-up interviews similarly demonstrated that migrants participated in various social activities to promote personal well-being and deeper social connections with Japanese, regardless of volunteering status.

Conclusions

Volunteering status itself was not significantly associated with mental well-being score among international migrants in Japan after adjusting for potential confounding variables. Beyond volunteering, having deeper social connections with the Japanese community is a key to promoting migrant mental well-being.

Building a Narrative of Equity: Weaving Indigenous Approaches into Community-Engaged Research

In 2020, global injustice has taken center stage during the uprising of the Black Lives Matter movement and other social movements. Activists are calling attention to longstanding disparities in health outcomes and an urgent need for justice. Given the global socio-political moment, how can health researchers draw on current critical theory and social movements to create structures for equitable outcomes in health research and practice? Here, we demonstrate principles for effective health research and social justice work that builds on community-engaged approaches by weaving critical Indigenous approaches into structural project designs. Our project, "Health Resilience among American Indians in Arizona", brought new and seasoned researchers together to collect and analyze data on the knowledge of healthcare providers concerning American Indian health and well-being. Four years after the conclusion of the project, the team developed and created a post-project self-assessment to investigate lasting impacts of project participation. In this communication, we discuss the principles of defining and measuring the capacity to build together. This work responds to the call from Indigenous scholars and community leaders to build an internal narrative of change. While we will not present the full instrument, we will discuss building a strong foundation using the principles of engagement for planning and implementing justice and change.

Engage for Equity: A Long-Term Study of Community-Based Participatory Research and Community-Engaged Research Practices and Outcomes

Community-based participatory research (CBPR) and community-engaged research have been established in the past 25 years as valued research approaches within health education, public health, and other health and social sciences for their effectiveness in reducing inequities. While early literature focused on partnering principles and processes, within the past decade, individual studies, as well as systematic reviews, have increasingly documented outcomes in community support and empowerment, sustained partnerships, healthier behaviors, policy changes, and health improvements. Despite enhanced focus on research and health outcomes, the science lags behind the practice. CBPR partnering pathways that result in outcomes remain little understood, with few studies documenting best practices. Since 2006, the University of New Mexico Center for Participatory Research with the University of Washington's Indigenous Wellness Research Institute and partners across the country has engaged in targeted investigations to fill this gap in the science. Our inquiry, spanning three stages of National Institutes of Health funding, has sought to identify which partnering practices, under which contexts and conditions, have capacity to contribute to health, research, and community outcomes. This article presents the research design of our current grant, Engage for Equity, including its history, social justice principles, theoretical bases, measures, intervention tools and resources, and preliminary findings about collective empowerment as our middle range theory of change. We end with lessons learned and recommendations for partnerships to engage in collective reflexive practice to strengthen internal power-sharing and capacity to reach health and social equity outcomes.

Engage for Equity: Development of Community-Based Participatory Research Tools

We developed a set of four community-based participatory research (CBPR) partnership tools aimed at supporting community-academic research partnerships in strengthening their research processes, with the ultimate goal of improving research outcomes. The aim of this article is to describe the tools we developed to accomplish this goal: (1) the River of Life Exercise; (2) a Partnership Visioning Exercise; (3) a personalized Partnership Data Report of data from academic and community research partners; and (4) a Promising Practices Guide with aggregated survey data analyses on promising CBPR practices associated with CBPR and health outcomes from two national samples of CBPR projects that completed a series of two online surveys. Relying on Paulo Freire's philosophy of praxis, or the cycles of collective reflection and action, we developed a set of tools designed to support research teams in holding discussions aimed at strengthening research partnership capacity, aligning research partnership efforts to achieve grant aims, and recalling and operationalizing larger social justice goals. This article describes the theoretical framework and process for tool development and provides preliminary data from small teams representing 25 partnerships who attended face-to-face workshops and provided their perceptions of tool accessibility and intended future use.

HIV-Related Stigma Among Black Mothers in Two North American and One African Cities

HIV-related stigma is a negative attitude or behaviour towards persons living with HIV, and is detrimental to effective care, management, and treatment of HIV. Using a revised 10-item stigma scale, we compared levels of HIV-related stigma and its correlates among Black women living with HIV in Ottawa, Canada, and Miami, FL, USA, with those in Port Harcourt, Nigeria. HIV-related stigma scores were calculated, with a maximum score of 10 and averaged 4.71 in Ottawa, 5.06 in Miami, and 3.78 in Port Harcourt. No significant difference in HIV-related stigma scores between Ottawa and Miami. HIV-related stigma was significantly (p < 0.05) higher among women in the North American cities compared with women in the African city. Hierarchical linear modelling shows that psychosocial variables contributed to variations in HIV-related stigma in Ottawa (22.3%), Miami (36.3%), and Port Harcourt (14.1%). At p < 0.05, discrimination was a significant predictor of increased HIV-related stigma in Ottawa (β = 0.077), Miami (β = 0.092), and Port Harcourt (β = 0.068). Functional social support had a significant diminishing effect on HIV-related stigma in Miami (β = - 0.108) and Port Harcourt (β = - 0.035). Tackling HIV-related sigma requires sociocultural considerations within specific regional and national contexts.

Guidance for Genuine Collaboration: Insights from Academic, Tribal, and Community Partner Interviews on a New Research Partnership

As community engaged research (CEnR) increases in popularity and recognition, specific guidance on partnership approaches that are more likely to lead to community benefits is needed. Here, we describe a qualitative interview study aimed at better understanding community and academic perspectives on elements of genuine collaboration within a project’s new community–academic partnership. This partnership involved a large, public, urban university, a tribal nation government program, a small, rural, community-based university, and a local high school working together to develop CEnR on air quality. Interview questions were formulated from a literature review examining the relationships between trust, cultural relevance, and community involvement in research with partnership processes, roles, and strengths. Twelve semi-structured interviews were conducted with individuals from the community–academic partnership: six University of Washington research team members and six community partners. Guidance for an authentic collaborative partnership supported by interview analyses includes incorporating elements of partnership and project sustainability from the earliest phases and throughout; promoting funding mechanism responsiveness to relationship building and community partner involvement in budget decision-making; acknowledging community strengths, knowledge, and expertise and applying them; establishing roles that reflect community partner capacity building goals; and recognizing community diversity and dynamics to promote representation.

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

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

A scoping review: The utility of participatory research approaches in psychology

Consistent with community psychology's focus on addressing societal problems by accurately and comprehensively capturing individuals' relationships in broader contexts, participatory research approaches aim to incorporate individuals' voices and knowledge into understanding, and responding to challenges and opportunities facing them and their communities. Although investigators in psychology have engaged in participatory research, overall, these approaches have been underutilized. The purpose of this review was to examine areas of research focus that have included participatory research methods and, in turn, highlight the strengths and ways that such methods could be better used by researchers. Nearly 750 articles about research with Indigenous Peoples, children/adolescents, forensic populations, people with HIV/AIDS, older adults, and in the area of industrial-organizational psychology were coded for their use of participatory research principles across all research stages (i.e., research design, participant recruitment and data collection, analysis and interpretation of results, and dissemination). Although we found few examples of studies that were fully committed to participatory approaches to research, and notable challenges with applying and reporting on this type of work, many investigators have developed creative ways to engage respectfully and reciprocally with participants. Based on our findings, recommendations and suggestions for researchers are discussed.

Power Dynamics in Community-Based Participatory Research: A Multiple-Case Study Analysis of Partnering Contexts, Histories, and Practices

Community-based participatory research has a long-term commitment to principles of equity and justice with decades of research showcasing the added value of power-sharing and participatory involvement of community members for achieving health, community capacity, policy, and social justice outcomes. Missing, however, has been a clear articulation of how power operates within partnership practices and the impact of these practices on outcomes. The National Institutes of Health-funded Research for Improved Health study (2009-2013), having surveyed 200 partnerships, then conducted seven in-depth case studies to better understand which partnership practices can best build from community histories of organizing to address inequities. The diverse case studies represented multiple ethnic-racial and other marginalized populations, health issues, and urban and rural areas and regions. Cross-cutting analyses of the qualitative results focus on how oppressive and emancipatory forms of power operate within partnerships in response to oppressive conditions or emancipatory histories of advocacy within communities. The analysis of power was conducted within each of the four domains of the community-based participatory research conceptual model, starting from how contexts shape partnering processes to impact short-term intervention and research outputs, and contribute to outcomes. Similarities and differences in how partnerships leveraged and addressed their unique contexts and histories are presented, with both structural and relational practices that intentionally addressed power relations. These results demonstrate how community members draw from their resilience and strengths to combat histories of injustice and oppression, using partnership principles and practices toward multilevel outcomes that honor community knowledge and leadership, and seek shared power, policy, and community transformation changes, thereby advancing health equity.

Culture-centeredness in community-based participatory research: contributions to health education intervention research

Health education research emphasizes the importance of cultural understanding and fit to achieve meaningful psycho-social research outcomes, community responsiveness and external validity to enhance health equity. However, many interventions address cultural fit through cultural competence and sensitivity approaches that are often superficial. The purpose of this study was to better situate culture within health education by operationalizing and testing new measures of the deeply grounded culture-centered approach (CCA) within the context of community-based participatory research (CBPR). A nation-wide mixed method sample of 200 CBPR partnerships included a survey questionnaire and in-depth case studies. The questionnaire enabled the development of a CCA scale using concepts of community voice/agency, reflexivity and structural transformation. Higher-order confirmatory factor analysis demonstrated factorial validity of the scale. Correlations supported convergent validity with positive associations between the CCA and partnership processes and capacity and health outcomes. Qualitative data from two CBPR case studies provided complementary socio-cultural historic background and cultural knowledge, grounding health education interventions and research design in specific contexts and communities. The CCA scale and case study analysis demonstrate key tools that community-academic research partnerships can use to assess deeper levels of culture centeredness for health education research.

Community-Based Participatory Intervention Research with American Indian Communities: What is the State of the Science?

We conducted a 2-phase systematic review of the literature to examine the nature and outcomes of health research using a community-based participatory research (CBPR) approach with AI communities to assess both the value and the impact of CBPR, identify gaps in knowledge, and guide recommendations for AI research agendas. Using PRISMA guidelines, we searched the peer-reviewed literature published from 1995 to 2016 and identified and reviewed 42 unique intervention studies. We identified and catalogued key study characteristics, and using the Reliability-Tested Guidelines for Assessing Participatory Research Projects, we quantified adherence to participatory research principles across its four domains. Finally, we examined any association between community participation score and health outcomes. The majority of studies (76.7%) used an observational study design with diabetes, cancer, substance abuse, and tobacco being the most common topics. Half of the articles reported an increase in knowledge as the primary outcome. Our findings suggest that a CBPR orientation yields improved community outcomes. However, we could not conclude that community participation was directly associated with an improvement in health outcomes.

Community-based participatory action research on rheumatic heart disease in an Australian Aboriginal homeland: Evaluation of the 'On track watch' project

Strategies to date have been ineffective in reducing high rates of rheumatic heart disease (RHD) in Australian Aboriginal people; a disease caused by streptococcal infections. A remote Aboriginal community initiated a collaboration to work towards elimination of RHD. Based in 'both-way learning' (reciprocal knowledge co-creation), the aim of this study was to co-design, implement and evaluate community-based participatory action research (CBPAR) to achieve this vision. Activities related to understanding and addressing RHD social determinants were delivered through an accredited course adapted to meet learner and project needs. Theory-driven evaluation linking CBPAR to empowerment was applied. Data collection comprised focus groups, interviews, observation, and co-development and use of measurement tools such as surveys. Data analysis utilised process indicators from national guidelines for Aboriginal health research, and outcome indicators derived from the Wallerstein framework. Findings include the importance of valuing traditional knowledges and ways of learning such as locally-meaningful metaphors to explore unfamiliar concepts; empowerment through critical thinking and community ownership of knowledge about RHD and research; providing practical guidance in implementing empowering and decolonising principles / theories. Lessons learned are applicable to next stages of the RHD elimination strategy which must include scale-up of community leadership in research agenda-setting and implementation.

Enhancing Community-Based Participatory Research Through Human-Centered Design Strategies

Introduction. The purpose of this review is to compare and contrast the values, purpose, processes, and outcomes of human-centered design (HCD) and community-based participatory research (CBPR) approaches to address public health issues and to provide recommendations for how HCD can be incorporated into CBPR partnerships and projects. Review Process. By consulting published literature, source materials, and experts on both approaches, a team of researchers completed a three-phased process of synthesizing key similarities and differences between HCD and CBPR and generating recommendations for ways to integrate HCD strategies in CBPR projects. Results. There are five HCD strategies that can be readily incorporated into CBPR projects to improve outcomes: (1) form transdisciplinary teams, (2) center empathy, (3) recruit and work with "extreme users," (4) rapidly prototype, and (5) create tangible products or services. Conclusions. Integrating HCD in CBPR projects may lead to solutions that potentially have greater reach, are more readily adopted, are more effective, and add innovation to public health services, products, and policies.

Disaster Exposure and Mental Health Among Puerto Rican Youths After Hurricane Maria

IMPORTANCE

Quantifying the magnitude of disaster exposure and trauma-related symptoms among youths is critical for deployment of psychological services in underresourced settings. Hurricane Maria made landfall in Puerto Rico on September 20, 2017, resulting in massive destruction and unprecedented mortality.

OBJECTIVE

To determine the magnitude of disaster exposure and mental health outcomes among Puerto Rican youths after Hurricane Maria.

DESIGN, SETTING, AND PARTICIPANTS

Survey study in which a school-based survey was administered to each public school student at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane Maria). Of the 226 808 students eligible to participate, 96 108 students completed the survey.

MAIN OUTCOMES AND MEASURES

Participants were assessed for exposure to hurricane-related stressors, posttraumatic stress disorder (PTSD), and depressive symptoms, using standardized self-report measures administered in Spanish. Descriptive statistics were compiled for all outcome variables, as was the frequency of individuals reporting clinically elevated symptoms of PTSD or depression. Differences in these statistics across sexes were also examined via t tests. Correlations between demographic, geographic, and main outcome variables were also calculated, and regressions were conducted to examine their association with symptoms of PTSD.

RESULTS

A total of 96 108 students participated in the study (42.4% response rate; 50.3% female), representative of grades 3 to 12 across all 7 educational regions of Puerto Rico. As a result of the hurricane, 83.9% of youths saw houses damaged, 57.8% had a friend or family member leave the island, 45.7% reported damage to their own homes, 32.3% experienced shortages of food or water, 29.9% perceived their lives to be at risk, and 16.7% still had no electricity 5 to 9 months after the hurricane. Overall, 7.2% of youths (n = 6900) reported clinically significant symptoms of PTSD; comparison of the frequency of reporting clinically elevated symptoms of PTSD across sex yielded a significant difference (t = 12.77; 95% CI of the difference, 0.018-0.025; P < .001), with girls (8.2%) exceeding the clinical cutoff score more often than boys (6.1%). Finally, similar analysis of differences in depression between sexes was also significant (t = 17.56; 95% CI of the difference, 0.31-0.39; P < .001), with girls displaying higher mean (SD) scores (2.72 [3.14]) than boys (2.37 [2.93]). Demographic and risk variables accounted for approximately 20% of variance in symptoms of PTSD (r2 = 0.195; 95% CI, 0.190-0.200).

CONCLUSIONS AND RELEVANCE

Survey results indicate that Hurricane Maria exposed Puerto Rican youths to high levels of disaster-related stressors, and youths reported high levels of PTSD and depressive symptoms. Results are currently being used by the Puerto Rico Department of Education to inform targeted and sustainable evidence-based practices aimed at improving mental health outcomes for Puerto Rico's youths.

Measuring institutional community engagement: Adding value to academic health systems

Beyond medical schools' historical focus on pillar missions including clinical care, education, and research, several medical schools now include community engagement (CE) as a mission. However, most academic health systems (AHSs) lack the tools to provide metrics, evaluation, and standardization for quantifying progress and contributions of the CE mission. Several nationwide initiatives, such as that driven by the Institute of Medicine recommending advances in CE metrics at institutions receiving Clinical and Translational Science Awards, have encouraged the research and development of systematic metrics for CE, but more progress is needed. The CE components practical model provides a foundation for analyzing and evaluating different types of CE activities at AHSs through five components: research, education, community outreach and community service, policy and advocacy, and clinical care. At the Medical College of Wisconsin (MCW), an annual survey administered to faculty and staff assessed the types and number of CE activities from the prior year. Survey results were combined to create a CE report for departments across the institution and inform MCW leadership. Insights gathered from the survey have contributed to next steps in CE tracking and evaluation, including the development of a CE dashboard to track CE activities in real time. The dashboard provides resources for how individuals can advance the CE mission through their work and guide CE at the institutional level.

Eliciting stakeholder preferences for patient-centered research

BACKGROUND

Rather than identifying exposures and outcomes for research solely based on interests of medical professionals, there is a need for research that answers questions that are important to patients, so that they may make treatment decisions based on evidence that reflect their individual preferences.

OBJECTIVE

To identify exposures and outcomes of interest that could be studied with electronic health record data from inpatient care.

DESIGN SETTING PARTICIPANTS

Mixed-methods analysis of semi-structured interviews administered in 2017 to 76 patients and 26 physicians who receive or provide care at Beth Israel Deaconess Medical Center in Boston, MA.

MEASUREMENTS

After conducting detailed semi-structured interviews about topics of interest that can be studied using electronic health records of inpatient care, we used an inductive approach to identify themes about the health care experience.

RESULTS

Participants reported concerns about adverse effects of medication changes, drug interactions, and surgery and other invasive procedures. The outcomes of greatest concern to them were in-hospital deaths and hospital-acquired infections. Participants commented on the importance of clear communication and information transfers, the hospital environment, accurate skills and knowledge, and upholding patient dignity and respect.

CONCLUSION

Engaging patients and physicians in the research development process provided insight to the exposures and outcomes they consider important. Our questions about exposures and outcomes of interest were restricted to topics that could be studied with electronic health record data from inpatient care, but using a similar approach to elicit feedback about the health care experience could be used to glean insight for other areas of future research.

From Bright Bodies to iChoose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia

This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Partnership Processes to Develop SHE Tribe: A Healthy Lifestyle Intervention

Chronic diseases, like diabetes and heart disease, disproportionately impact women of color as compared to White women. Community-engaged and participatory approaches are proposed as a means to address chronic disease health disparities in minority communities, as they allow for tailoring and customization of strategies that align with community needs, interests, and priorities. While community-based participatory research (CBPR) is a framework that offers a clear set of principles to guide intervention design and development, the complexity and diversity of community contexts make it challenging to anticipate all of the possible pathways to implementation. This article describes the application of CBPR principles in the design and development of SHE Tribe (She's Healthy and Empowered), a social network-based healthy lifestyle intervention intended to promote the adoption of sustainable health behaviors in underserved communities. Practical and specific strategies are described to aid practitioners, researchers, and community partners as they engage in community-academic partnerships. These strategies uncover some of the inner workings of this partnership to promote trust and collaboration and maximize partner strengths, with the aim to aid others with key elements and practical steps in the application of participatory methods.