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Lachance L, Brush BL, Mentz G, Lee SYD, Chandanabhumma PP, Coombe CM, DeMajo R, Gabrysiak A, Jensen M, Reyes AG, Rowe Z, Schulz AJ, Wilson-Powers E, Israel BA. Validation of the Measurement Approaches to Partnership Success (MAPS) Questionnaire. Health Educ Behav 2024; 51:218-228. [PMID: 38083870 DOI: 10.1177/10901981231213352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Conceptualizing and testing factors that contribute to the success of community-academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test-retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.
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Affiliation(s)
- Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Graciela Mentz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
- University of Michigan School of Medicine, Department of Anesthesia, Ann Arbor, MI USA
| | | | | | - Chris M Coombe
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ricardo DeMajo
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Adena Gabrysiak
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | | | - Amy J Schulz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Barbara A Israel
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Carmona G, Sawant K, Hamasha R, Cross FL, Woolford SJ, Buyuktur AG, Burke Bailey S, Rowe Z, Marsh E, Israel B, Platt J. Use of the socio-ecological model to explore trusted sources of COVID-19 information in Black and Latinx communities in Michigan. J Commun Healthc 2023; 16:389-400. [PMID: 37942823 PMCID: PMC10872920 DOI: 10.1080/17538068.2023.2277499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Identifying trusted sources of health information and exploring what makes these sources trustworthy is an important aspect of public health. This exploration requires embracing the cultural differences in minoritized communities, which are often treated as homogeneous. This qualitative study identifies and analyze the sources of trusted COVID-19 information among Black and Latinx communities in Michigan and assesses the rationale underlying this trust. METHODS Interviews were conducted with 24 Black and 16 Latinx participants (n = 40) in four Michigan counties significantly impacted by COVID-19. The socio-ecological model was applied as an analytical framework for understanding the entities considered trusted sources of information. Within each level of the model, the dimensions of trustworthiness most salient for participants were identified. RESULTS We found that sources of information came from all levels of the model, including interpersonal (COVID-19 survivors, church representatives, friends, relatives), organizational (employers, healthcare providers, traditional news reports), social media (hybrid source), community (members and groups), and public policy (county health department, federal and state government). Furthermore, participants determined whether they could trust information about COVID-19 by cross-referencing multiple resources. We identified competence, confidence, communication, and system trust as the dimensions of trustworthiness most often reported by participants. CONCLUSIONS Our research suggests public health communications should engage in cross-referencing practices, providing information from sources at all levels of interaction, cultural competency, and awareness of historical/structural inequities. These efforts would be further strengthened by attending to needs for both factual information as well as care and personal connection.
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Affiliation(s)
- Gloria Carmona
- Department of Learning Health Sciences, Medical School, University of Michigan, Michigan, USA
| | | | | | | | - Susan J Woolford
- Department of Pediatrics University of Michigan, Susan B Meister Child Health Evaluation and Research Center
| | - Ayse G Buyuktur
- Michigan Institute for Clinical & Health Research, University of Michigan
| | - Sarah Burke Bailey
- Michigan Institute for Clinical & Health Research, University of Michigan
| | | | - Erica Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School
| | - Barbara Israel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan
| | - Jodyn Platt
- Department of Learning Health Sciences, Medical School, University of Michigan, Michigan, USA
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Coombe CM, Simbeni S, Neal A, Allen AJ, Gray C, Guzman JR, Lichtenstein RL, Marsh EE, Piechowski P, Reyes AG, Rowe Z, Weinert J, Israel BA. Erratum: Building the foundation for equitable and inclusive research: Seed grant programs to facilitate development of diverse CBPR community-academic research partnerships - CORRIGENDUM. J Clin Transl Sci 2023; 7:e216. [PMID: 37900354 PMCID: PMC10603386 DOI: 10.1017/cts.2023.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
[This corrects the article DOI: 10.1017/cts.2022.495.].
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Coombe CM, Simbeni S, Neal A, Allen AJ, Gray C, Guzman JR, Lichtenstein RL, Marsh EE, Piechowski P, Reyes AG, Rowe Z, Weinert J, Israel BA. Building the foundation for equitable and inclusive research: Seed grant programs to facilitate development of diverse CBPR community-academic research partnerships. J Clin Transl Sci 2022; 7:e2. [PMID: 36755548 PMCID: PMC9879886 DOI: 10.1017/cts.2022.495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/20/2022] [Accepted: 10/29/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The effectiveness of community-based participatory research (CBPR) partnerships to address health inequities is well documented. CBPR integrates knowledge and perspectives of diverse communities throughout the research process, following principles that emphasize trust, power sharing, co-learning, and mutual benefits. However, institutions and funders seldom provide the time and resources needed for the critical stage of equitable partnership formation and development. Methods Since 2011, the Detroit Urban Research Center, collaborating with other entities, has promoted the development of new community-academic research partnerships through two grant programs that combine seed funding with capacity building support from community and academic instructors/mentors experienced in CBPR. Process and outcomes were evaluated using mixed methods. Results From 2011 to 2021, 50 partnerships received grants ranging from $2,500 to $30,000, totaling $605,000. Outcomes included equitable partnership infrastructure and processes, innovative pilot research, translation of findings to interventions and policy change, dissemination to multiple audiences, new proposals and projects, and sustained community-academic research partnerships. All partnerships continued beyond the program; over half secured additional funding. Conclusions Keys to success included participation as community-academic teams, dedicated time for partnership/relationship development, workshops to develop equity-based skills, relationships, and projects, expert community-academic instructor guidance, and connection to additional resources. Findings demonstrate that small amounts of seed funding for newly forming community-academic partnerships, paired with capacity building support, can provide essential time and resources needed to develop diverse, inclusive, equity-focused CBPR partnerships. Building such support into funding initiatives and through academic institutions can enhance impact and sustainability of translational research toward advancing health equity.
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Affiliation(s)
- Chris M. Coombe
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sophia Simbeni
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Neal
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | | | - Carol Gray
- Michigan Social Health Interventions to Eliminate Disparities (MSHIELD), University of Michigan, Ann Arbor, MI, USA
| | | | | | - Erica E. Marsh
- Michigan Institute for Clinical & Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | - Patricia Piechowski
- Michigan Institute for Clinical & Health Research (MICHR), University of Michigan, Ann Arbor, MI, USA
| | | | | | - Julia Weinert
- Poverty Solutions, University of Michigan, Ann Arbor, MI, USA
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Lachance L, Coombe CM, Brush BL, Lee SYD, Jensen M, Taffe B, Bhardwaj P, Muhammad M, Wilson-Powers E, Rowe Z, Caldwell CH, Israel BA. Understanding the Benefit-Cost Relationship in Long-standing Community-based Participatory Research (CBPR) Partnerships: Findings from the Measurement Approaches to Partnership Success (MAPS) Study. J Appl Behav Sci 2022; 58:513-536. [PMID: 36016649 PMCID: PMC9398184 DOI: 10.1177/0021886320972193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
As part of the Measurement Approaches to Partnership Success (MAPS) study, we investigated the relationship between benefits and costs of participation in long-standing community-based participatory research (CBPR) partnerships using social exchange theory as a theoretical framework. Three major findings were identified: (1) the concept of benefits and costs operating as a ratio, where individual benefits must outweigh costs for participation, applies to early stages of CBPR partnership formation; (2) as CBPR partnerships develop, the benefits and costs of participation include each other's needs and the needs of the group as a whole; and (3) there is a shift in the relationship of benefits and costs over time in long-standing CBPR partnerships, in which partners no longer think in terms of costs but rather investments that contribute to mutual benefits.
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Affiliation(s)
- Laurie Lachance
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Chris M Coombe
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Barbara L Brush
- University of Michigan School of Nursing, Department of Systems, Populations and Leadership, 426 North Ingalls Building; Ann Arbor, MI 48109-2003, USA
| | - Shoou-Yih Daniel Lee
- University of Michigan School of Public Health, Department of Health Management & Policy, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Megan Jensen
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Brianna Taffe
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Prachi Bhardwaj
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Michael Muhammad
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Eliza Wilson-Powers
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
| | - Zachary Rowe
- Friends of Parkside, 5000 Conner Street; Detroit, MI 48213, USA
| | - Cleopatra H Caldwell
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029. USA
| | - Barbara A Israel
- University of Michigan School of Public Health, Department of Health Behavior & Health Education, 1415 Washington Heights; Ann Arbor, MI 48109-2029, USA
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Calhoun K, Burns T, Smith A, Ehrlich E, Gultekin L, Asabigi K, Hijazi M, Buckhoy N, Rowe Z, Neff M, Vaughter D, Voepel-Lewis T, Piechowski T, Jazdzyk D, Cordova D. A Community-Academic Approach to Preventing Substance Use Disorders. Prog Community Health Partnersh 2022; 16:45-58. [PMID: 35912657 DOI: 10.1353/cpr.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic and activism against structural racism heightened awareness of racial-ethnic disparities and disproportionate burden among the underserved. The opioid crisis further compounds these phenomena, increasing vulnerability for substance use disorders (SUD). Community-based participatory research can facilitate multidisciplinary collaboration, yet literature on these approaches to prevent and reduce SUD and associated stigma remains limited. OBJECTIVE Discrimination, stigma, and multiple crises with health care and systemic barriers increasingly marginalize the underserved, specifically around SUD. The Detroit Area Mental Health Leadership Team (DAMHLT, since 2015), aims to optimize SUD prevention, enhance resiliency and advocacy to advance knowledge on SUD research and influence community-level research and practice. LESSONS LEARNED DAMHLT's approach on bidirectionality, community level access to real-time epidemiological data, advocacy (i.e., institutional responsiveness) and dissemination may be translational to other partnerships. CONCLUSIONS As we move through an ever-changing pandemic, DAMHLT's lessons learned can inform partnership dynamics and public health strategies such as hesitancy on public health response.
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Gronlund CJ, Ketenci KC, Reames TG, Larson PS, Schott J, Rowe Z, Jenkins QS, Sanca MO, Tournat T, Sol K, Williams D, Gijsbers E, O’Neill MS. Indoor apparent temperature, cognition, and daytime sleepiness among low-income adults in a temperate climate. Indoor Air 2022; 32:e12972. [PMID: 34888941 PMCID: PMC8992972 DOI: 10.1111/ina.12972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/31/2021] [Accepted: 11/26/2021] [Indexed: 06/13/2023]
Abstract
The burden of temperature-associated mortality and hospital visits is significant, but temperature's effects on non-emergency health outcomes is less clear. This burden is potentially greater in low-income households unable to afford efficient heating and cooling. We examined short-term associations between indoor temperatures and cognitive function and daytime sleepiness in low-income residents of Detroit, Michigan. Apparent temperature (AT, based on temperature and humidity) was recorded hourly in 34 participant homes between July 2019-March 2020. Between July-October 2019, 18 participants were administered word list immediate (WLL) and delayed (WLD) recall tests (10-point scales) and the Epworth Sleepiness Scale (24-point scale) 2-4 times. We applied longitudinal models with nonlinear distributed lags of temperature up to 7 days prior to testing. Indoor temperatures ranged 8-34°C overall and 15-34°C on survey days. We observed a 0.4 (95% CI: 0.0, 0.7) point increase in WLL and 0.4 (95% CI: 0.0, 0.9) point increase in WLD scores per 2°C increase in AT. Results suggested decreasing sleepiness scores with decreasing nighttime AT below 22°C. Low-income Detroit residents experience uncomfortably high and low indoor temperatures. Indoor temperature may influence cognitive function and sleepiness, although we did not observe deleterious effects of higher temperatures.
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Affiliation(s)
- Carina J. Gronlund
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Kaan Cem Ketenci
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | - Tony G. Reames
- University of Michigan School for the Environment and Sustainability, Ann Arbor, MI, USA
| | - Peter S. Larson
- University of Michigan Institute for Social Research, Ann Arbor, MI, USA
| | | | | | | | - Mario O. Sanca
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Troy Tournat
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ketlyne Sol
- University of Michigan Department of Psychology, Ann Arbor, MI, USA
| | - Don’aa Williams
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emma Gijsbers
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marie S. O’Neill
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Su-En Lee M, Beathard E, Kirch M, Solway E, Lewallen M, Tipirneni R, Patel M, Rowe Z, Goold SD. Self-Reported Health Status Improved For Racial And Ethnic Minority Groups After Michigan Medicaid Expansion. Health Aff (Millwood) 2021; 40:1637-1643. [PMID: 34606344 DOI: 10.1377/hlthaff.2020.02296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Addressing health inequities for racial and ethnic minority populations is challenging. After passage of the Affordable Care Act, Michigan launched its Healthy Michigan Plan, which expanded Medicaid eligibility in the state. Our evaluation of the expansion provided the opportunity to study its impact on racial and ethnic minority groups, including Arab American and Chaldean American enrollees, an understudied population. Using data from telephone surveys collected in 2016, 2017, and 2018, we conducted an analysis to study the plan's impact on access to a regular source of care and health status among racial and ethnic minority groups. More than 90 percent of respondents of all racial and ethnic groups reported having a regular source of care after plan enrollment compared with 74.4 percent before enrollment. Respondents who identified as non-Hispanic White, African American, and Hispanic reported improvements in health status after plan enrollment. Our study demonstrates the potential of health insurance access to narrow health inequities between racial and ethnic groups.
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Affiliation(s)
- Melinda Su-En Lee
- Melinda Su-En Lee is CEO and cofounder of Parcel Health, Inc., in Pittsburgh, Pennsylvania. At the time this work was performed, she was a graduate student in the College of Pharmacy, University of Michigan, in Ann Arbor, Michigan
| | - Erin Beathard
- Erin Beathard is the Medicaid policy lead in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Matthias Kirch
- Matthias Kirch is the lead data analyst in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Erica Solway
- Erica Solway is the senior project manager in the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Maryn Lewallen
- Maryn Lewallen was a research area specialist intermediate in the Center for Bioethics and Social Sciences in Medicine, University of Michigan, when this work was performed. She now resides in Lahore, Pakistan
| | - Renu Tipirneni
- Renu Tipirneni is an assistant professor in the Department of Internal Medicine, University of Michigan Medical School, in Ann Arbor, Michigan
| | - Minal Patel
- Minal Patel is an associate professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health, in Ann Arbor, Michigan
| | - Zachary Rowe
- Zachary Rowe is the executive director of Friends of Parkside, in Detroit, Michigan
| | - Susan D Goold
- Susan D. Goold is a professor in the Department of Internal Medicine, University of Michigan Medical School, and the Department of Health Management and Policy, University of Michigan School of Public Health
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Nong P, Raj M, Trinidad MG, Rowe Z, Platt J. Understanding racial differences in attitudes about public health efforts during COVID-19 using an explanatory mixed methods design. Soc Sci Med 2021; 287:114379. [PMID: 34520940 PMCID: PMC8425672 DOI: 10.1016/j.socscimed.2021.114379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/29/2021] [Accepted: 09/04/2021] [Indexed: 10/28/2022]
Abstract
Efforts to mitigate the spread of COVID-19 rely on trust in public health organizations and practices. These practices include contact tracing, which requires people to share personal information with public health organizations. The central role of trust in these practices has gained more attention during the pandemic, resurfacing endemic questions about public trust and potential racial trust disparities, especially as they relate to participation in public health efforts. Using an explanatory mixed methods design, we conducted quantitative analysis of state-level survey data in the United States from a representative sample of Michigan residents (n = 1000) in May 2020. We used unadjusted and adjusted linear regressions to examine differences in trust in public health information and willingness to participate in public health efforts by race. From July to September 2020, we conducted qualitative interviews (n = 26) to further explain quantitative results. Using unadjusted linear regression, we observed higher willingness to participate in COVID-19 public health efforts among Black survey respondents compared to White respondents. In adjusted analysis, that difference disappeared, yielding no statistically significant difference between Black and White respondents in either trust in public health information sources or willingness to participate. Qualitative interviews were conducted to explain these findings, considering their contrast with assumptions that Black people would exhibit lower trust in public health organizations during COVID-19. Altruism, risk acknowledgement, trust in public health organizations during COVID-19, and belief in efficacy of public health efforts contributed to willingness to participate in public health efforts among interviewees. Our findings underscore the contextual nature of trust, and the importance of this context when analyzing protective health behaviors among communities disproportionately affected by COVID-19. Assumptions about mistrust among Black individuals and communities may be inaccurate because they overlook the specific context of the public health crisis. These findings are important because they indicate that Black respondents are exhibiting strategic trust during COVID-19 despite systemic, contemporary, and historic barriers to trust. Conceptual specificity rather than blanket generalizations is warranted, especially given the harms of stereotyping and discrimination.
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Affiliation(s)
- Paige Nong
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Minakshi Raj
- University of Illinois Department of Kinesiology and Community Health, USA.
| | - Marie Grace Trinidad
- University of Michigan Department of Learning Health Sciences, 300 N Ingalls St, Ann Arbor, MI, 48109, USA.
| | - Zachary Rowe
- Friends of Parkside, 5000 Connor St, Detroit, MI, 48213, USA
| | - Jodyn Platt
- University of Michigan Department of Learning Health Sciences, 300 N Ingalls St, Ann Arbor, MI, 48109, USA.
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10
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Israel BA, Lachance L, Coombe CM, Lee SYD, Jensen M, Wilson-Powers E, Mentz G, Muhammad M, Rowe Z, Reyes AG, Brush BL. Measurement Approaches to Partnership Success: Theory and Methods for Measuring Success in Long-Standing Community-Based Participatory Research Partnerships. Prog Community Health Partnersh 2021; 14:129-140. [PMID: 32280130 DOI: 10.1353/cpr.2020.0015] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Numerous conceptual frameworks have been developed to understand how community-based participatory research (CBPR) partnerships function, and multiple measurement approaches have been designed to evaluate them. However, most measures are not validated, and have focused on new partnerships. To define and assess the meaning of success in long-standing CBPR partnerships, we are conducting a CBPR study, Measurement Approaches to Partnership Success (MAPS). In this article we describe the theoretical underpinnings and methodological approaches used. OBJECTIVES The objectives of this study are to 1) develop a questionnaire to evaluate success in long-standing CBPR partnerships, 2) test the psychometric qualities of the questionnaire, 3) assess the relationships between key variables and refine the questionnaire and theoretical model, and 4) develop mechanisms and a feedback tool to apply partnership evaluation findings. METHODS Methodological approaches have included: engaged a community-academic national Expert Panel; conducted key informant interviews with Expert Panel; conducted a scoping literature review; conducted a Delphi process with the Expert Panel; and revised the measurement instrument. Additional methods include: conduct cognitive interviews and pilot testing; revise and test final version of the questionnaire with long-standing CBPR partnerships; examine the reliability and validity; analyze the relationship among variables in the framework; revise the framework; and develop a feedback mechanism for sharing partnership evaluation results. CONCLUSIONS Through the application of a theoretical model and multiple methodological approaches, the MAPS study will result in a validated measurement instrument and will develop procedures for effectively feeding back evaluation findings in order to strengthen authentic partnerships to achieve health equity.
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11
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Coombe CM, Chandanabhumma PP, Bhardwaj P, Brush BL, Greene-Moton E, Jensen M, Lachance L, Lee SD, Meisenheimer M, Minkler M, Muhammad M, Reyes AG, Rowe Z, Wilson-Powers E, Israel BA. A Participatory, Mixed Methods Approach to Define and Measure Partnership Synergy in Long-standing Equity-focused CBPR Partnerships. Am J Community Psychol 2020; 66:427-438. [PMID: 32744781 PMCID: PMC7772255 DOI: 10.1002/ajcp.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Understanding what contributes to success of community-based participatory research (CBPR) partnerships is essential to ensuring their effectiveness in addressing health disparities and health inequities. Synergy, the concept of accomplishing more together than separately, is central to partnership effectiveness. However, synergy specific to long-standing, equity-focused CBPR partnerships has not been closely examined. To address this, we defined and developed measures of partnership synergy as one dimension of a participatory mixed methods study, Measurement Approaches to Partnership Success (MAPS), to develop a validated instrument to measure success in long-standing CBPR partnerships. Framed by a conceptual model and scoping literature review, we conducted in-depth interviews with a national panel of academic and community experts in CBPR and equity to develop partnership synergy measures. Items were refined through an iterative process, including a three-stage Delphi process, comparison with existing measures, cognitive interviews, and pilot testing. Seven questionnaire items were developed to measure synergy arising from equitable partnerships bringing together diverse partners across power differences to promote equity. Defining and measuring synergy in the context of long-standing partnership success is central to understanding the role of synergy in collaborative approaches to research and action and can strengthen CBPR partnerships to promote healthy communities and advance health equity.
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Affiliation(s)
- Chris M. Coombe
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Prachi Bhardwaj
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | | | - Megan Jensen
- University of Michigan School of Public Health, Ann Arbor, MI
| | - Laurie Lachance
- University of Michigan School of Public Health, Ann Arbor, MI
| | - S.Y. Daniel Lee
- University of Michigan School of Public Health, Ann Arbor, MI
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12
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Goold S, Tipirneni R, Ayanian J, Beathard E, Chang T, Haggins A, Kieffer E, Kirch M, Kullgren J, Lee S, Lewallen M, Patel M, Rowe Z, Solway E, Clark S. Patterns of Enrollment Churn in Medicaid Expansion, Subsequent Insurance Coverage, and Access to Care: A Longitudinal Study. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- S. Goold
- University of Michigan Ann Arbor MI United States
| | - R. Tipirneni
- University of Michigan Ann Arbor MI United States
| | - J. Ayanian
- University of Michigan Ann Arbor MI United States
| | - E. Beathard
- Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI United States
| | - T. Chang
- Department of Family Medicine University of Michigan Ann Arbor MI United States
| | - A. Haggins
- University of Michigan Ann Arbor MI United States
| | - E. Kieffer
- University of Michigan Ann Arbor MI United States
| | - M. Kirch
- University of Michigan Ann Arbor MI United States
| | - J.T. Kullgren
- Division of General Medicine Department of Internal Medicine University of Michigan Ann Arbor MI United States
| | - S. Lee
- Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI United States
| | - M. Lewallen
- University of Michigan Ann Arbor MI United States
| | - M. Patel
- School of Public Health University of Michigan Ann Arbor MI United States
| | - Z. Rowe
- Friends of Parkside Detroit MI United States
| | - E. Solway
- Institute for Healthcare Policy and Innovation University of Michigan Ann Arbor MI United States
| | - S.J. Clark
- University of Michigan Ann Arbor MI United States
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Tipirneni R, Kieffer E, Ayanian J, Patel M, Kirch M, Luster J, Beathard E, Haggins A, Kullgren J, Chang T, Clark S, Lee S, Solway E, Rowe Z, Goold S. Longitudinal Trends in Enrollees’ Employment and Student Status after Medicaid Expansion. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- R. Tipirneni
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan Ann Arbor MI United States
| | - E.C. Kieffer
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan School of Social Work Ann Arbor MI United States
| | - J.Z. Ayanian
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan Gerald R. Ford School of Public Policy Ann Arbor MI United States
- University of Michigan School of Public Health Ann Arbor MI United States
- Department of Internal Medicine University of Michigan Ann Arbor MI United States
| | - M.R. Patel
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan School of Public Health Ann Arbor MI United States
| | - M.A. Kirch
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
| | - J. Luster
- Department of Internal Medicine University of Michigan Ann Arbor MI United States
| | - E. Beathard
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
| | - A.N. Haggins
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- Department of Emergency Medicine University of Michigan Ann Arbor MI United States
| | - J.T. Kullgren
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- VA Ann Arbor Center for Clinical Management Research Ann Arbor MI United States
- Center for Bioethics and Social Sciences in Medicine University of Michigan Ann Arbor MI United States
- University of Michigan Medical School and School of Public Health Ann Arbor MI United States
| | - T. Chang
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- Department of Family Medicine University of Michigan Ann Arbor MI United States
| | - S.J. Clark
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan Ann Arbor MI United States
| | - S. Lee
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan Institute for Social Research Ann Arbor MI United States
| | - E. Solway
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
| | - Z. Rowe
- Friends of Parkside Detroit MI United States
| | - S.D. Goold
- University of Michigan Institute for Healthcare Policy and Innovation Ann Arbor MI United States
- University of Michigan School of Public Health Ann Arbor MI United States
- Department of Internal Medicine University of Michigan Ann Arbor MI United States
- Center for Bioethics and Social Sciences in Medicine University of Michigan Ann Arbor MI United States
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Patel MR, Tipirneni R, Kieffer EC, Kullgren JT, Ayanian JZ, Chang T, Solway E, Beathard E, Kirch M, Lee S, Clark S, Skillicorn J, Rowe Z, Goold SD. Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017. JAMA Netw Open 2020; 3:e208776. [PMID: 32648922 PMCID: PMC7352154 DOI: 10.1001/jamanetworkopen.2020.8776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states. OBJECTIVE To examine the self-reported health of enrollees in Michigan's Medicaid expansion, the Healthy Michigan Plan (HMP), over time. DESIGN, SETTING, AND PARTICIPANTS A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018. MAIN OUTCOMES AND MEASURES Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097). RESULTS Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P < .001), with the largest decreases observed in respondents who were non-Hispanic black (from 31.5% [95% CI, 27.1%-35.9%] in 2016 to 26.0% [95% CI, 21.9%-30.1%] in 2017; P = .009), from the Detroit metropolitan area (from 30.7% [95% CI, 27.0%-34.4%] in 2016 to 24.9% [95% CI, 21.6%-28.3%] in 2017; P = .001), and with an income of 0% to 35% of the federal poverty level (from 37.6% [95% CI, 34.2%-40.9%] in 2016 to 32.3% [95% CI, 29.1%-35.5%] in 2017; P < .001). From 2016 to 2017, the mean number of days of poor physical health in the past month decreased significantly from 6.9 (95% CI, 6.5-7.4) to 5.7 (95% CI, 5.3-6.0) (coefficient, -6.10; P < .001), including among current (from 7.0 [95% CI, 6.5-7.5] to 5.6 [95% CI, 5.1-6.0]; P < .001) and former (from 6.8 [95% CI, 5.9-7.7] to 5.8 [95% CI, 5.0-6.7]; P = .02) enrollees, those with 2 or more chronic conditions (from 9.9 [95% CI, 9.3-10.6] to 8.5 [95% CI, 7.8-9.1]; P < .001), across all age groups (19-34 years, from 4.3 [95% CI, 3.7-4.9] to 3.0 [95% CI, 2.5-3.5]; P < .001; 35-50 years, from 8.2 [95% CI, 7.3-9.0] to 6.9 [95% CI, 6.1-7.7]; P = .002; 51-64 years, from 9.0 [95% CI, 8.2-9.8] to 7.6 [95% CI, 6.9-8.3]; P = .001), and among non-Hispanic white (from 7.5 [95% CI, 7.0-8.1] to 6.1 [95% CI, 5.6-6.6]; P < .001) and black (from 5.9 [95% CI, 5.1-6.8] to 4.4 [95% CI, 3.6-5.1]; P < .001) respondents. No changes in days of poor mental health or usual activities missed owing to poor physical or mental health were observed. CONCLUSIONS AND RELEVANCE These findings suggest that HMP enrollees in Michigan have experienced improvements in self-reported health over time, including minority groups with a history of health disparities and enrollees with chronic health conditions.
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Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Edith C. Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- School of Social Work, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- US Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | - John Z. Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Erin Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sunghee Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Sarah Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Jennifer Skillicorn
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | | | - Susan D. Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
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15
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Myers CD, Gordon HG, Kim HM, Rowe Z, Goold SD. Does Group Deliberation Mobilize? The Effect of Public Deliberation on Willingness to Participate in Politics. Polit Behav 2020; 42:557-580. [PMID: 32367900 PMCID: PMC7197766 DOI: 10.1007/s11109-018-9507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Proponents of public deliberation suggest that engaging in deliberation increases deliberators' subsequent participation in other forms of politics. We evaluate this "deliberative participation hypothesis" using data drawn from a deliberative field experiment in which members of medically underserved communities in Michigan deliberated in small groups about the design of that state's Medicaid program. Participants were randomly assigned to deliberate about the program in a group or to think about the decision individually, and then completed a post-survey that included measures of willingness to engage in a variety of political acts. We measured willingness to engage in common forms of political participation, as well as willingness to participate in particularistic resistance to adverse decisions by insurance bureaucracies. Contrary to the claims of much of the existing literature, we find no impact of deliberation on willingness to engage in political participation. These results suggest that the ability of public deliberation to increase broader political engagement may be limited or may only occur in particularly intensive, directly empowered forms of public deliberation.
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Affiliation(s)
- C Daniel Myers
- Department of Political Science, University of Minnesota
| | | | - Hyungjin Myra Kim
- Center for Statistical Consulting & Research, University of Michigan
| | | | - Susan Dorr Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan
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16
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Myers CD, Kieffer EC, Fendrick AM, Kim HM, Calhoun K, Szymecko L, LaHahnn L, Ledón C, Danis M, Rowe Z, Goold SD. How Would Low-Income Communities Prioritize Medicaid Spending? J Health Polit Policy Law 2020; 45:373-418. [PMID: 32084263 PMCID: PMC9450686 DOI: 10.1215/03616878-8161024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CONTEXT Medicaid plays a critical role in low-income, minority, and medically underserved communities, particularly in states that have expanded Medicaid under the Affordable Care Act. Yet, the voices of underresourced communities are often unheard in decisions about how to allocate Medicaid's scarce resources, and traditional methods of public engagement are poorly suited to gathering such input. We argue that deliberative public engagement can be a useful tool for involving communities in setting Medicaid priorities. METHOD We engaged 209 residents of low-income, medically underserved Michigan communities in discussions about Medicaid spending priorities using an exercise in informed deliberation: CHAT (CHoosing All Together). Participants learned about Medicaid, deliberated in small groups, and set priorities both individually and collectively. FINDINGS Participants prioritized broad eligibility consistent with the ACA expansion, accepted some cost sharing, and prioritized spending in areas-including mental health-that are historically underfunded. Participants allocated less funding beyond benefit coverage, such as spending on healthy communities. Participants perceived the deliberative process as fair and informative, and they supported using it in the policy-making process. CONCLUSION The choices of participants from low-income, medically underserved communities reflect a unique set of priorities and suggest that engaging low-income communities more deeply in Medicaid policy making might result in different prioritization decisions.
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17
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Goold SD, Tipirneni R, Chang T, Kirch MA, Bryant C, Rowe Z, Beathard E, Solway E, Lee S, Clark SJ, Skillicorn J, Ayanian JZ, Kullgren JT. Primary Care, Health Promotion, and Disease Prevention with Michigan Medicaid Expansion. J Gen Intern Med 2020; 35:800-807. [PMID: 31792868 PMCID: PMC7080942 DOI: 10.1007/s11606-019-05370-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medicaid expansion in Michigan, known as the Healthy Michigan Plan (HMP), emphasizes primary care and preventive services. OBJECTIVE Evaluate the impact of enrollment in HMP on access to and receipt of care, particularly primary care and preventive services. DESIGN Telephone survey conducted during January-November 2016 with stratified random sampling by income and geographic region (response rate = 53.7%). Logistic regression analyses accounted for sampling and nonresponse adjustment. PARTICIPANTS 4090 HMP enrollees aged 19-64 with ≥ 12 months of HMP coverage MAIN MEASURES: Surveys assessed demographic factors, health, access to and use of health care before and after HMP enrollment, health behaviors, receipt of counseling for health risks, and knowledge of preventive services' copayments. Utilization of preventive services was assessed using Medicaid claims. KEY RESULTS In the 12 months prior to HMP enrollment, 33.0% of enrollees reported not getting health care they needed. Three quarters (73.8%) of enrollees reported having a regular source of care (RSOC) before enrollment; 65.1% of those reported a doctor's office/clinic, while 16.2% reported the emergency room. After HMP enrollment, 92.2% of enrollees reported having a RSOC; 91.7% had a doctor's office/clinic and 1.7% the emergency room. One fifth (20.6%) of enrollees reported that, before HMP enrollment, it had been over 5 years since their last primary care visit. Enrollees who reported a visit with their primary care provider after HMP enrollment (79.3%) were significantly more likely than those who did not report a visit to receive counseling about health behaviors, improved access to cancer screening, new diagnoses of chronic conditions, and nearly all preventive services. Enrollee knowledge that some services have no copayments was also associated with greater utilization of most preventive services. CONCLUSIONS After enrolling in Michigan's Medicaid expansion program, beneficiaries reported less forgone care and improved access to primary care and preventive services.
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Affiliation(s)
- Susan Dorr Goold
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. .,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Renuka Tipirneni
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Matthias A Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Corey Bryant
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | | | - Erin Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Sunghee Lee
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Sarah J Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Skillicorn
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - John Z Ayanian
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey T Kullgren
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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18
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Coombe CM, Schulz AJ, Brakefield-Caldwell W, Gray C, Guzman JR, Kieffer EC, Lewis T, Reyes AG, Rowe Z, Israel BA. Applying Experiential Action Learning Pedagogy to an Intensive Course to Enhance Capacity to Conduct Community-Based Participatory Research. ACTA ACUST UNITED AC 2019; 6:168-182. [PMID: 34350338 DOI: 10.1177/2373379919885975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community-based participatory research (CBPR) is widely recognized as an effective approach to understand and address health inequities. Opportunities for public health practitioners and researchers to engage jointly with community partners in intensive colearning processes can build capacity for CBPR. Using active learning approaches that engage diverse partners can enhance partnership development, competence, and equity. Examination of such pedagogical approaches can strengthen understanding of their contributions to the effectiveness of CBPR capacity-building programs. This article describes a weeklong intensive course carried out by the Detroit Urban Research Center as the foundation for a yearlong training program to build the capacity of community-academic partnership teams to engage in CBPR in their own communities. The in-person CBPR course was developed and implemented by expert academic and community instructors and used an experiential action learning model that integrated CBPR principles and processes. We describe the course content and application of our collaborative, experiential action learning model to course design; present results from participant evaluation of course effectiveness, CBPR competence, and equitable partnership development; and examine the contributions of the pedagogical approach to outcomes central to successful CBPR. The participatory, formative course evaluation used multiple methods that included closed- and open-ended questionnaires to assess instructional effectiveness, participant competence on 12 core components of CBPR, and course impact on partner relationships. Evaluation findings suggest that an experiential action learning approach with attention to colearning, collaboration among diverse instructors and participants, and an environment that fosters and models equitable and trusting relationships can be effective in building CBPR capacity.
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Affiliation(s)
| | | | | | - Carol Gray
- University of Michigan, Ann Arbor, MI, USA
| | - J Ricardo Guzman
- Community Health and Social Services Center, Inc., Detroit, MI, USA
| | | | - Toby Lewis
- University of Michigan, Ann Arbor, MI, USA
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
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19
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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 Educ Behav 2019; 47:556-568. [PMID: 31619072 DOI: 10.1177/1090198119882989] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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20
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Goold SD, Danis M, Abelson J, Gornick M, Szymecko L, Myers CD, Rowe Z, Kim HM, Salman C. Evaluating community deliberations about health research priorities. Health Expect 2019; 22:772-784. [PMID: 31251446 PMCID: PMC6737773 DOI: 10.1111/hex.12931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 04/05/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Engaging underrepresented communities in health research priority setting could make the scientific agenda more equitable and more responsive to their needs. OBJECTIVE Evaluate democratic deliberations engaging minority and underserved communities in setting health research priorities. METHODS Participants from underrepresented communities throughout Michigan (47 groups, n = 519) engaged in structured deliberations about health research priorities in professionally facilitated groups. We evaluated some aspects of the structure, process, and outcomes of deliberations, including representation, equality of participation, participants' views of deliberations, and the impact of group deliberations on individual participants' knowledge, attitudes, and points of view. Follow-up interviews elicited richer descriptions of these and also explored later effects on deliberators. RESULTS Deliberators (age 18-88 years) overrepresented minority groups. Participation in discussions was well distributed. Deliberators improved their knowledge about disparities, but not about health research. Participants, on average, supported using their group's decision to inform decision makers and would trust a process like this to inform funding decisions. Views of deliberations were the strongest predictor of these outcomes. Follow-up interviews revealed deliberators were particularly struck by their experience hearing and understanding other points of view, sometimes surprised at the group's ability to reach agreement, and occasionally activated to volunteer or advocate. CONCLUSIONS Deliberations using a structured group exercise to engage minority and underserved community members in setting health research priorities met some important criteria for a fair, credible process that could inform policy. Deliberations appeared to change some opinions, improved some knowledge, and were judged by participants worth using to inform policymakers.
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Affiliation(s)
- Susan Dorr Goold
- Department of Internal Medicine, Division of General Medicine, Institute for Healthcare Policy and InnovationCenter for Bioethics and Social Sciences in MedicineAnn ArborMichigan
| | - Marion Danis
- Warren Magnuson Clinical CenterNational Institutes of HealthBethesdaMaryland
| | - Julia Abelson
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Michelle Gornick
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
| | - Lisa Szymecko
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
| | - C. Daniel Myers
- Department of Political ScienceUniversity of MinnesotaMinneapolisMinnesota
| | | | - Hyungjin Myra Kim
- Center for Statistical Computation and ResearchUniversity of MichiganAnn ArborMichigan
| | - Cengiz Salman
- Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborMichigan
- Present address:
Department of American Culture, College of Literature, Science and the ArtsUniversity of MichiganAnn ArborMichigan
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21
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Coombe CM, Schulz AJ, Guluma L, Allen AJ, Gray C, Brakefield-Caldwell W, Guzman JR, Lewis TC, Reyes AG, Rowe Z, Pappas LA, Israel BA. Enhancing Capacity of Community-Academic Partnerships to Achieve Health Equity: Results From the CBPR Partnership Academy. Health Promot Pract 2018; 21:552-563. [PMID: 30596283 DOI: 10.1177/1524839918818830] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Community-based participatory research (CBPR) is an equitable partnership approach that links academic researchers, community organizations, and public health practitioners to work together to understand and address health inequities. Although numerous educational materials on CBPR exist, few training programs develop the skills and knowledge needed to establish effective, equitable partnerships. Furthermore, there are few professional development opportunities for academic researchers, practitioners, and community members to obtain these competencies in an experiential co-learning process. In response, the Detroit Community-Academic Urban Research Center developed the CBPR Partnership Academy, an innovative, yearlong capacity-building program facilitated by experienced community and academic partners, involving an intensive short course, partnership development, grant proposal preparation and funding, mentoring, online learning forums, and networking. Three diverse cohorts (36 teams) from 18 states and 2 tribal nations have participated. We describe the rationale and components of the training program and present results from the first two cohorts. Evaluation results suggest enhanced competence and efficacy in conducting CBPR. Outcomes include partnerships established, grant proposals submitted and funded, workshops and research conducted, and findings disseminated. A community-academic partner-based, integrated, applied program can be effective for professional development and establishing innovative linkages between academics and practitioners aimed at achieving health equity.
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Affiliation(s)
| | | | | | | | - Carol Gray
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
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Abstract
The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.
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Affiliation(s)
- R Mehdipanah
- School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - A J Schulz
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - B A Israel
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - C Gamboa
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Z Rowe
- Friends of Parkside, Detroit, MI, USA
| | - M Khan
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - A Allen
- Chandler Park Conservancy, Detroit, MI, USA
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Goold SD, Tipirneni R, Kieffer E, Haggins A, Salman C, Solway E, Szymecko L, Chang T, Rowe Z, Clark S, Lee S, Campbell EG, Ayanian JZ. Primary Care Clinicians' Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study. J Gen Intern Med 2018; 33:1307-1316. [PMID: 29948813 PMCID: PMC6082204 DOI: 10.1007/s11606-018-4487-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 02/21/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Michigan's approach to Medicaid expansion, the Healthy Michigan Plan (HMP), emphasizes primary care, prevention, and incentives for patients and primary care practitioners (PCPs). OBJECTIVE Assess PCPs' perspectives about the impact of HMP on their patients and practices. DESIGN In 2014-2015, we conducted semi-structured interviews then a statewide survey of PCPs. SETTING Interviewees came from varied types of practices in five Michigan regions selected for racial/ethnic diversity and a mix of rural and urban settings. Surveys were sent via mail. PARTICIPANTS Interviewees were physician (n = 16) and non-physician practitioners (n = 3). All Michigan PCPs caring for ≥ 12 HMP enrollees were surveyed (response rate 55.5%, N = 2104). MEASUREMENTS PCPs' experiences with HMP patients and recent changes in their practices. RESULTS Interviews include examples of the impact of Medicaid expansion on patients and practices. A majority of surveyed PCPs reported recent increases in new patients (52.3%) and patients who had not seen a PCP in many years (56.2%). For previously uninsured patients, PCPs reported positive impact on control of chronic conditions (74.4%), early detection of serious illness (71.1%), medication adherence (69.1%), health behaviors (56.5%), emotional well-being (57.0%), and the ability to work, attend school, or live independently (41.5%). HMP patients reportedly still had more difficulty than privately insured patients accessing some services. Most PCPs reported that their practices had, in the past year, hired clinicians (53.2%) and/or staff (57.5%); 15.4% had colocated mental health care. Few (15.8%) reported established patients' access to urgent appointments worsened. LIMITATIONS PCP reports of patient experiences may not be accurate. Results reflect the experiences of PCPs with ≥ 12 Medicaid patients. Differences between respondents and non-respondents present the possibility for response bias. CONCLUSIONS PCPs reported improved patient access to care, medication adherence, chronic condition management, and detection of serious illness. Established patients' access did not diminish, perhaps due to reported practice changes.
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Affiliation(s)
- Susan Dorr Goold
- Department of Internal Medicine, Medical School, University of Michigan, 2800 Plymouth Road, 425W, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Renuka Tipirneni
- Department of Internal Medicine, Medical School, University of Michigan, 2800 Plymouth Road, 425W, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Edith Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- School of Social Work and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Adrianne Haggins
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Emergency Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Cengiz Salman
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Szymecko
- Department of Community Psychology, Michigan State University, East Lansing, MI, USA
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Sarah Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Sunghee Lee
- The Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Eric G Campbell
- CU Center for Bioethics and Humanities, University of Colorado, Denver, CO, USA
| | - John Z Ayanian
- Department of Internal Medicine, Medical School, University of Michigan, 2800 Plymouth Road, 425W, Ann Arbor, MI, 48109, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA
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Mehdipanah R, Schulz AJ, Israel BA, Mentz G, Eisenberg A, Stokes C, Rowe Z. Neighborhood Context, Homeownership and Home Value: An Ecological Analysis of Implications for Health. Int J Environ Res Public Health 2017; 14:E1098. [PMID: 28937613 PMCID: PMC5664599 DOI: 10.3390/ijerph14101098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/04/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022]
Abstract
While homeownership has been linked to positive health outcomes there is limited evidence regarding the conditions under which it may be health protective. We present a conceptual model linking homeownership to health, highlighting key potential pathways. Using the Detroit Metropolitan Area as a case study, and data from the American Community Survey (2009-2013; 5-years estimates) and Michigan Department of Community Health, we tested the following questions: (1) Is neighborhood percentage non-Hispanic Black (NHB) associated with homeownership? (2) Is neighborhood percentage NHB associated with health? (3) Is the association between percentage NHB and health mediated by homeownership? (4) Does neighborhood housing value modify associations between percentage NHB and health, or between homeownership and health? Percentage NHB was associated with homeownership and health outcomes; Associations between percentage NHB and mortality, but not disability, were partially mediated by neighborhood homeownership. Neighborhood housing value modified associations between neighborhood homeownership and both disability and mortality, but not between percentage NHB and health outcomes. Findings are consistent with the thesis that health-promoting effects of homeownership may be contingent upon house values. These results add to a limited body of evidence suggesting that variations in homeownership may contribute to persistent racial and socioeconomic health inequities.
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Affiliation(s)
| | - Amy J Schulz
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Barbara A Israel
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Graciela Mentz
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Alexa Eisenberg
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Carmen Stokes
- School of Nursing, University of Detroit Mercy, Detroit, MI 48221, USA.
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Goold S, Rowe Z, Calhoun K, Campbell T, Danis M, Hammad A, Salman C, Szymecko L, Coombe C. The State as Community in Community-Based Participatory Research. Prog Community Health Partnersh 2017; 10:515-522. [PMID: 28569676 DOI: 10.1353/cpr.2016.0059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community-based participatory research (CBPR) typically defines communities by geography, ethnicity, shared health needs, or some combination. OBJECTIVES We describe a CBPR project aiming to engage diverse minority and underserved communities throughout Michigan in deliberations about health research priorities. METHODS A steering committee (SC) with 15 members from minority and underserved communities and 4 members from research organizations led the project, with the help of regional advisory groups (RAGs) formed at the SC's request. Evaluation of the SC used questionnaires, focused group discussion, and review of SC meetings to describe engagement, partnership, and communication. LESSONS LEARNED An academic-community partnership with a diverse, dispersed, and broadly defined community found value in RAGs, dedicated academic staff, face-to-face meetings, varied communication modalities, capacity building tailored to varying levels of CBPR experience, and ongoing evaluation. CONCLUSIONS A geographically and culturally diverse partnership presents challenges and opportunities in representativeness, relationship building, capacity building, and communication.
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Schulz AJ, Mentz GB, Kwarteng J, Israel BA, Gamboa C, Sand SL, Gaines C, Reyes AG, Rowe Z. Do Neighborhood Demographics Modify Walking Group Intervention Effectiveness in Urban Neighborhoods? Health Promot Pract 2017; 18:62-74. [PMID: 27357203 PMCID: PMC9254165 DOI: 10.1177/1524839916655081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We assessed the effects of neighborhood composition on effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing cardiovascular risk (CVR) in low-to-moderate-income, predominantly non-Latino Black (NLB) and Latino communities. METHOD Multilevel models assessed modifying effects of neighborhood composition on (1) WYHH adherence/participation at 8 weeks and 32 weeks, (2) associations between participation and steps, and (3) associations between steps and CVR. RESULTS Approximately 90% of participants were women. Neither neighborhood poverty nor racial composition modified intervention participation at 8 weeks. At 32 weeks, residents of high percentage-NLB neighborhoods that also had high poverty rates had reduced participation. Neighborhood composition did not modify associations between participation and steps or between steps and CVR. Neighborhood percentage poverty and NLB were positively associated with CVR. CONCLUSION Positive associations between participation in the WYHH program and physical activity, and CVR did not differ by neighborhood composition. Efforts to address challenges to long-term participation are warranted for residents of racially segregated, high-poverty neighborhoods. Residents of racially segregated neighborhoods with high concentrations of poverty experience disproportionately high risk for cardiovascular disease and can benefit from interventions such as WYHH that increase physical activity and reduce CVR.
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Affiliation(s)
- Amy J Schulz
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Graciela B Mentz
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Barbara A Israel
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cindy Gamboa
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sharon L Sand
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Angela G Reyes
- 4 Detroit Hispanic Development Corporation, Detroit, MI, USA
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Pattin A, Rowe Z, Kilgore PE, Farhat N, Kaurala S, Kaljee L. Engagement in a Diverse Urban Community to Describe Community Residents’ Perceptions of Pharmacists as Immunizers. Innov Pharm 2016. [DOI: 10.24926/iip.v7i2.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To describe the perceptions of pharmacist-delivered vaccination services among community members that live in a diverse urban metropolitan area and to identify potential strategies to improve the use of vaccines provided by pharmacists.
Design: Qualitative study. Setting: Metropolitan urban diverse community in Wayne County, MI. Participants: Individuals 50 years of age and older that reside in a defined urban metropolitan community. Intervention: Four, 45-minute, focus group discussions were conducted to gather the experiences and perceptions of participants around pharmacists that immunize. A focus group guide was developed to facilitate focus group sessions. Main Outcome Measures: Focus group discussions were audio-recorded and transcribed. Content analysis was used to analyze data and identify relevant themes. Results: Three main themes were identified related to the use of pharmacist-delivered vaccination services: trust with vaccine providers, interaction with pharmacy personnel, and the factor of accessibility. Conclusion: Study participants expressed views that will guide the development of interventions aimed to reduce disparities in vaccine utilization. It is suggested that future efforts improve accessibility to pharmacy-delivered vaccines in this community and enhance the interaction between patients and pharmacists.
Type: Original Research
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Goold SD, Myers CD, Szymecko L, Cunningham Collins C, Martinez S, Ledón C, Campbell TR, Danis M, Cargill SS, Kim HM, Rowe Z. Priorities for Patient-Centered Outcomes Research: The Views of Minority and Underserved Communities. Health Serv Res 2016; 52:599-615. [PMID: 27206519 DOI: 10.1111/1475-6773.12505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To learn how minority and underserved communities would set priorities for patient-centered outcomes research (PCOR). DATA SOURCES Sixteen groups (n = 183) from minority and underserved communities in two states deliberated about PCOR priorities using the simulation exercise CHoosing All Together (CHAT). Most participants were minority, one-third reported income <$10,000, and one-fourth reported fair/poor health. DESIGN Academic-community partnerships adapted CHAT for PCOR priority setting using existing research agendas and interviews with community leaders, clinicians, and key informants. DATA COLLECTION Tablet-based CHAT collected demographic information, individual priorities before and after group deliberation, and groups' priorities. PRINCIPAL FINDINGS Individuals and groups prioritized research on Quality of Life, Patient-Doctor, Access, Special Needs, and (by total resources spent) Compare Approaches. Those with less than a high school education were less likely to prioritize New Approaches, Patient-Doctor, Quality of Life, and Families/Caregivers. Blacks were less likely to prioritize research on Causes of Disease, New Approaches, and Compare Approaches than whites. Compare Approaches, Special Needs, Access, and Families/Caregivers were significantly more likely to be selected by individuals after compared to before deliberation. CONCLUSIONS Members of underserved communities, in informed deliberations, prioritized research on Quality of Life, Patient-Doctor, Special Needs, Access, and Compare Approaches.
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Affiliation(s)
- Susan Dorr Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - C Daniel Myers
- Department of Political Science, University of Minnesota, Minneapolis, MN
| | - Lisa Szymecko
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | | | - Sal Martinez
- Community Renewal and Development, Inc., St. Louis, MO
| | | | - Terrance R Campbell
- Wayne State University College of Education VAC Program, YOUR Center, Flint, MI
| | - Marion Danis
- Department of Bioethics, National Institutes of Health, Bethesda, MD
| | - Stephanie Solomon Cargill
- Department of Health Care Ethics, Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, MO
| | - Hyungjin Myra Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI
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Caldwell WB, Reyes AG, Rowe Z, Weinert J, Israel BA. Community Partner Perspectives on Benefits, Challenges, Facilitating Factors, and Lessons Learned from Community-Based Participatory Research Partnerships in Detroit. Prog Community Health Partnersh 2015; 9:299-311. [PMID: 26412771 DOI: 10.1353/cpr.2015.0031] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is an extensive body of literature on community-based participatory research (CBPR) and the role of community-academic partnerships, much of which has involved community partners in the conceptualization and preparation of publications. However, there has been a relative dearth of solely community voices addressing these topics, given the other roles and responsibilities which community members and leaders of community-based organizations (CBOs) have. PURPOSE The purpose of this article is to share the perspectives of three long-time (>20 years) community partners involved in the Detroit Community-Academic Urban Research Center and its affiliated partnerships. CONCLUSION In this article, we community partners provide our assessment of the benefits and challenges in using a CBPR approach at the personal, organizational, and community levels; the factors that facilitate effective partnerships; and our lessons learned through engagement in CBPR. We also present specific recommendations from a community perspective to researchers and institutions interested in conducting CBPR.
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Du L, Batterman S, Godwin C, Rowe Z, Chin JY. Air exchange rates and migration of VOCs in basements and residences. Indoor Air 2015; 25:598-609. [PMID: 25601281 PMCID: PMC4490136 DOI: 10.1111/ina.12178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 05/06/2023]
Abstract
UNLABELLED Basements can influence indoor air quality by affecting air exchange rates (AERs) and by the presence of emission sources of volatile organic compounds (VOCs) and other pollutants. We characterized VOC levels, AERs, and interzonal flows between basements and occupied spaces in 74 residences in Detroit, Michigan. Flows were measured using a steady-state multitracer system, and 7-day VOC measurements were collected using passive samplers in both living areas and basements. A walk-through survey/inspection was conducted in each residence. AERs in residences and basements averaged 0.51 and 1.52/h, respectively, and had strong and opposite seasonal trends, for example, AERs were highest in residences during the summer, and highest in basements during the winter. Airflows from basements to occupied spaces also varied seasonally. VOC concentration distributions were right-skewed, for example, 90th percentile benzene, toluene, naphthalene, and limonene concentrations were 4.0, 19.1, 20.3, and 51.0 μg/m(3), respectively; maximum concentrations were 54, 888, 1117, and 134 μg/m(3). Identified VOC sources in basements included solvents, household cleaners, air fresheners, smoking, and gasoline-powered equipment. The number and type of potential VOC sources found in basements are significant and problematic, and may warrant advisories regarding the storage and use of potentially strong VOCs sources in basements. PRACTICAL IMPLICATIONS Few IAQ studies have examined basements. A sizable volume of air can flow between the basement and living area, and AERs in these two zones can differ considerably. In many residences, the basement contains significant emission sources and contributes a large fraction of VOC concentrations found in the living area. Exposures can be lowered by removing VOC sources from the basement; other exposure management options, such as local ventilation or isolation, are unlikely to be practical.
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Affiliation(s)
- Liuliu Du
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Stuart Batterman
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Corresponding Author: Stuart Batterman School of Public Health, University of Michigan, Room 6075 SPH2, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. Tel: +1 734 763 2417; Fax: +1 734 763 8095;
| | | | | | - Jo-Yu Chin
- New York State Department of Health, Albany, NY, USA
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Sharp AL, Chang T, Cobb E, Gossa W, Rowe Z, Kohatsu L, Heisler M. Exploring real-time patient decision-making for acute care: a pilot study. West J Emerg Med 2015; 15:675-81. [PMID: 25247042 PMCID: PMC4162728 DOI: 10.5811/westjem.2014.5.20410] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 05/15/2014] [Accepted: 05/27/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Research has described emergency department (ED) use patterns in detail. However, evidence is lacking on how, at the time a decision is made, patients decide if healthcare is required or where to seek care. Methods Using community-based participatory research methods, we conducted a mixed-methods descriptive pilot study. Due to the exploratory, hypothesis-generating nature of this research, we did not perform power calculations, and financial constraints only allowed for 20 participants. Hypothetical vignettes for the 10 most common low acuity primary care complaints (cough, sore throat, back pain, etc.) were texted to patients twice daily over six weeks, none designed to influence the patient’s decision to seek care. We conducted focus groups to gain contextual information about participant decision-making. Descriptive statistics summarized responses to texts for each scenario. Qualitative analysis of open-ended text message responses and focus group discussions identified themes associated with decision-making for acute care needs. Results We received text survey responses from 18/20 recruited participants who responded to 72% (1092/1512) of the texted vignettes. In 48% of the vignettes, participants reported they would do nothing, for 34% of the vignettes participants reported they would seek care with a primary care provider, and 18% of responses reported they would seek ED care. Participants were not more likely to visit an ED during “off-hours.” Our qualitative findings showed: 1) patients don’t understand when care is needed; 2) patients don’t understand where they should seek care. Conclusion Participants were unclear when or where to seek care for common acute health problems, suggesting a need for patient education. Similar research is necessary in different populations and regarding the role of urgent care in acute care delivery.
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Affiliation(s)
- Adam L Sharp
- Southern California Kaiser Permanente, Department of Research and Evaluation, Pasadena, California ; University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan
| | - Tammy Chang
- University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Family Medicine, Ann Arbor, Michigan
| | - Enesha Cobb
- University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Emergency Medicine, Ann Arbor, Michigan ; Center for Clinical Management Research, Ann Arbor VA Health System, Ann Arbor, Michigan
| | - Weyinshet Gossa
- University of Michigan, Department of Family Medicine, Ann Arbor, Michigan
| | | | | | - Michele Heisler
- University of Michigan, Robert Wood Johnson Foundation Clinical Scholars Program, Ann Arbor, Michigan ; University of Michigan, Institute for Health Policy and Innovation, Ann Arbor, Michigan ; University of Michigan, Department of Internal Medicine, Ann Arbor, Michigan ; Center for Clinical Management Research, Ann Arbor VA Health System, Ann Arbor, Michigan
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Johnson-Lawrence V, Schulz AJ, Zenk SN, Israel BA, Wineman J, Marans RW, Rowe Z. Joint Associations of Residential Density and Neighborhood Involvement With Physical Activity Among a Multiethnic Sample of Urban Adults. Health Educ Behav 2015; 42:510-7. [PMID: 25626432 PMCID: PMC6987981 DOI: 10.1177/1090198114564500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Regular physical activity is associated with improvements in overall health. Although resident involvement in neighborhood social activities is positively associated with physical activity, neighborhood design features, including residential density, have varied associations with physical activity. Using data from a multiethnic sample of 696 adults in Detroit, Michigan, multilevel models were used to examine joint effects of residential density and resident involvement in neighborhood activities in relation to physical activity. We found a marginally significant negative interaction of higher residential density and resident neighborhood involvement. Higher residential density was negatively associated with physical activity, and resident neighborhood involvement was positively associated with physical activity. Our findings suggest that future work incorporate additional neighborhood and individual-level characteristics to understand the complexity of the association between the neighborhood environment, resident social engagement in the neighborhood, and physical activity.
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Affiliation(s)
| | - Amy J Schulz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Barbara A Israel
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Izumi BT, Schulz AJ, Mentz G, Israel BA, Sand SL, Reyes AG, Hoston B, Richardson D, Gamboa C, Rowe Z, Diaz G. Leader Behaviors, Group Cohesion, and Participation in a Walking Group Program. Am J Prev Med 2015; 49:41-9. [PMID: 26094226 PMCID: PMC4476063 DOI: 10.1016/j.amepre.2015.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 01/14/2015] [Accepted: 01/26/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Less than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. The purpose of this study is to examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low to moderate-income communities in Detroit, Michigan. DESIGN Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multisite cluster RCT with a lagged intervention and outcome measurements at baseline and 4, 8, and 32 weeks. Pooled survey data from both intervention arms were used for the current study. Data were analyzed between August 2013 and October 2014. SETTING/PARTICIPANTS A total of 603 non-Hispanic black, non-Hispanic white, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011. INTERVENTION The intervention was a 32-week walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90 minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time. MAIN OUTCOME MEASURES Participation in WYHH as measured by consistency of attendance. RESULTS Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation. CONCLUSIONS Providing leaders with training to build socially cohesive groups may help motivate individuals to continue participation in community-based physical activity programs.
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Affiliation(s)
- Betty T Izumi
- School of Community Health, Portland State University, Portland, Oregon.
| | - Amy J Schulz
- School of Public Health, University of Michigan, Ann Arbor
| | - Graciela Mentz
- School of Public Health, University of Michigan, Ann Arbor
| | | | - Sharon L Sand
- School of Public Health, University of Michigan, Ann Arbor
| | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, Michigan
| | | | - Dawn Richardson
- School of Community Health, Portland State University, Portland, Oregon
| | - Cindy Gamboa
- School of Public Health, University of Michigan, Ann Arbor
| | | | - Goya Diaz
- School of Public Health, University of Michigan, Ann Arbor
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Schulz AJ, Israel BA, Mentz GB, Bernal C, Caver D, DeMajo R, Diaz G, Gamboa C, Gaines C, Hoston B, Opperman A, Reyes AG, Rowe Z, Sand SL, Woods S. Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: findings from the walk your heart to health intervention. Health Educ Behav 2015; 42:380-92. [PMID: 25819980 DOI: 10.1177/1090198114560015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. METHOD WYHH was a 32-week community health promoter-facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers. RESULTS Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (β = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks. CONCLUSION The WYHH community health promoter-facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.
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Affiliation(s)
- Amy J Schulz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Barbara A Israel
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Graciela B Mentz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cristina Bernal
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Deanna Caver
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ricardo DeMajo
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Gregoria Diaz
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cindy Gamboa
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Bernadine Hoston
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Angela G Reyes
- Detroit Hispanic Development Corporation, Detroit, MI, USA
| | | | - Sharon L Sand
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Sachiko Woods
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Chang T, Gossa W, Sharp A, Rowe Z, Kohatsu L, Cobb EM, Heisler M. Text messaging as a community-based survey tool: a pilot study. BMC Public Health 2014; 14:936. [PMID: 25201051 PMCID: PMC4169823 DOI: 10.1186/1471-2458-14-936] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is not known whether using text messaging to administer real-time survey questions is feasible and acceptable among low-income, urban African American adults. METHODS We used a mixed methods approach including paper surveys, surveys administered by text message, and a focus group. Survey questions that included multiple choice, Likert-like scales, and open ended questions were administered by paper and sent via text message daily during varied times of day for six weeks. RESULTS In our study sample (n = 20), 90% of participants were female, and 100% were African American, with a median age of 30.7 years. Participants responded to 72% (1092/1512) of all multiple choice questions sent by text message and 76% (55/72) of the questions requiring responses on Likert-like scales. Content of responses on the paper and text message surveys did not differ. All participants reported in the focus group that they preferred text message surveys over other survey modalities they have used in the past (paper, phone, internet, in-person) due to ease and convenience. CONCLUSION Text messaging is not only acceptable and feasible but is the preferred method of collecting real-time survey data in a low-income urban African-American community.
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Affiliation(s)
- Tammy Chang
- />Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA
| | - Weyinshet Gossa
- />Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI 48104-1213 USA
| | - Adam Sharp
- />Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA 91101 USA
| | - Zachary Rowe
- />Friends of Parkside, 5000 Conner Street, Detroit, MI 48213 USA
| | - Lauren Kohatsu
- />University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104 USA
| | - Enesha M Cobb
- />Department of Emergency Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Taubman Center B1-354, Ann Arbor, MI 48109 USA
- />VA Health Services Research & Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System, 1500 East Medical Center Drive, Taubman Center B1-354, Ann Arbor, MI 48109 USA
| | - Michele Heisler
- />University of Michigan Robert Wood Johnson Foundation Clinical Scholars Program, 2800 Plymouth Rd, Building 10, Room G016, Ann Arbor, MI 48109 USA
- />Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive SPC 5352, Ann Arbor, MI 48109 USA
- />VA Health Services Research & Development Center of Excellence, Veterans Affairs Ann Arbor Healthcare System, 1500 East Medical Center Drive, Taubman Center B1-354, Ann Arbor, MI 48109 USA
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Batterman S, Du L, Parker E, Robins T, Lewis T, Mukherjee B, Ramirez E, Rowe Z, Brakefield-Caldwell W. Use of Free-standing Filters in an Asthma Intervention Study. Air Qual Atmos Health 2013; 6:759-767. [PMID: 24436726 PMCID: PMC3889137 DOI: 10.1007/s11869-013-0216-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This study characterizes the use of HEPA air filters provided to 89 households participating in an intervention study investigating the respiratory health of children with asthma. Freestanding filters were placed in the child's bedroom and monitored continuously for nearly a year in each household. Filter use was significantly affected by study phase, season and monitoring week. During the "intensive" weeks when a community education worker and a field technician visited the household, the use rate averaged 70±33%. During season-long "non-intensive" periods between seasonal visits, use dropped to 34±30%. Filter use rapidly decreased during the 3 to 4 weeks following each intensive, was slightly higher in spring, summer, and in the evening and at night when the child was likely to be home, although households did not follow consistent diurnal patterns. While participants expressed an understanding of the benefits of filter use and reported good experiences with them, use rates were low, particularly during unobserved non-intensive periods. The provision of freestanding air filters to individuals or households must be considered an active intervention that requires monitoring and evaluation, otherwise unknown and unexpected patterns of filter use may alter and possibly bias results due to exposure misclassification.
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Affiliation(s)
- Stuart Batterman
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Corresponding Author: School of Public Health, University of Michigan, Room 6075 SPH2, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. Tel: +1 734 763 2417; Fax: +1 734 763 8095; (S. Batterman)
| | - Liuliu Du
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Edith Parker
- College of Public Health, University of Iowa, Iowa City, IA 51503, USA
| | - Thomas Robins
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Toby Lewis
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- School of Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bhramar Mukherjee
- School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
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Batterman S, Du L, Mentz G, Mukherjee B, Parker E, Godwin C, Chin JY, O'Toole A, Robins T, Rowe Z, Lewis T. Particulate matter concentrations in residences: an intervention study evaluating stand-alone filters and air conditioners. Indoor Air 2012; 22:235-52. [PMID: 22145709 PMCID: PMC4233141 DOI: 10.1111/j.1600-0668.2011.00761.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
UNLABELLED This study, a randomized controlled trial, evaluated the effectiveness of free-standing air filters and window air conditioners (ACs) in 126 low-income households of children with asthma. Households were randomized into a control group, a group receiving a free-standing HEPA filter placed in the child's sleeping area, and a group receiving the filter and a window-mounted AC. Indoor air quality (IAQ) was monitored for week-long periods over three to four seasons. High concentrations of particulate matter (PM) and carbon dioxide were frequently seen. When IAQ was monitored, filters reduced PM levels in the child's bedroom by an average of 50%. Filter use varied greatly among households and declined over time, for example, during weeks when pollutants were monitored, filter use was initially high, averaging 84±27%, but dropped to 63±33% in subsequent seasons. In months when households were not visited, use averaged only 34±30%. Filter effectiveness did not vary in homes with central or room ACs. The study shows that measurements over multiple seasons are needed to characterize air quality and filter performance. The effectiveness of interventions using free-standing air filters depends on occupant behavior, and strategies to ensure filter use should be an integral part of interventions. PRACTICAL IMPLICATIONS Environmental tobacco smoke (ETS) increased particulate matter (PM) levels by about 14 μg/m3 and was often detected using ETS-specific tracers despite restrictions on smoking in the house as reported on questionnaires administered to caregivers. PM concentrations depended on season, filter usage, relative humidity, air exchange ratios, number of children, outdoor PM levels, sweeping/dusting, and presence of a central air conditioner (AC). Free-standing air filters can be an effective intervention that provides substantial reductions in PM concentrations if the filters are used. However, filter use was variable across the study population and declined over the study duration, and thus strategies are needed to encourage and maintain use of filters. The variability in filter use suggests that exposure misclassification is a potential problem in intervention studies using filters. The installation of a room AC in the bedroom, intended to limit air exchange ratios, along with an air filter, did not lower PM levels more than the filter alone.
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Affiliation(s)
- S Batterman
- School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Schulz AJ, Israel BA, Coombe CM, Gaines C, Reyes AG, Rowe Z, Sand S, Strong LL, Weir S. A community-based participatory planning process and multilevel intervention design: toward eliminating cardiovascular health inequities. Health Promot Pract 2011; 12:900-11. [PMID: 21873580 PMCID: PMC3212629 DOI: 10.1177/1524839909359156] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The elimination of persistent health inequities requires the engagement of multiple perspectives, resources, and skills. Community-based participatory research (CBPR) is one approach to developing action strategies that promote health equity by addressing contextual as well as individual-level factors, and that can contribute to addressing more fundamental factors linked to health inequity. Yet many questions remain about how to implement participatory processes that engage local insights and expertise, are informed by the existing public health knowledge base, and build support across multiple sectors to implement solutions. This article describes a CBPR approach used to conduct a community assessment and action planning process, culminating in development of a multilevel intervention to address inequalities in cardiovascular disease in Detroit, Michigan. The authors consider implications for future efforts to engage communities in developing strategies toward eliminating health inequities.
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Affiliation(s)
- Amy J. Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Rm. 2822, Ann Arbor, MI; 734-647-0221; FAX 734-763-7379;
| | - Barbara A. Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Rm. 2822, Ann Arbor, MI; 734-647-0221; FAX 734-763-7379;
| | - Chris M. Coombe
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Rm. 2822, Ann Arbor, MI; 734-647-0221; FAX 734-763-7379;
| | | | | | | | - Sharon Sand
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Rm. 2822, Ann Arbor, MI; 734-647-0221; FAX 734-763-7379;
| | - Larkin L. Strong
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
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Strong LL, Israel BA, Schulz AJ, Reyes A, Rowe Z, Weir SS, Poe C. Piloting interventions within a community-based participatory research framework: lessons learned from the healthy environments partnership. Prog Community Health Partnersh 2009; 3:327-34. [PMID: 20097994 PMCID: PMC2820110 DOI: 10.1353/cpr.0.0094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Community-based participatory research (CBPR) partnerships experience unique opportunities and dilemmas when implementing pilot interventions. OBJECTIVES We describe challenges and opportunities associated with conducting a pilot intervention within a longstanding CBPR partnership, lessons learned for use of a participatory process to pilot community interventions, and recommendations to funders on mechanisms for funding pilot interventions to help address these challenges. METHODS We conducted key informant interviews and convened a group discussion with host organization leaders and project personnel. LESSONS LEARNED Findings highlight the opportunities and challenges related to needs and desires of community constituents and the ability of pilot interventions to meet those needs, and the importance of ongoing communication to address anticipated and unanticipated challenges that arise in the context of short-term pilot interventions in community settings. CONCLUSION We suggest several funding mechanisms for supporting the implementation of larger scale interventions following promising pilot efforts in community settings.
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Affiliation(s)
- Larkin L. Strong
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Barbara A Israel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Amy J. Schulz
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Angela Reyes
- Detroit Hispanic Development Corporation, Detroit, MI
| | | | | | - Cecil Poe
- Leland Missionary Baptist Church, Detroit, MI
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Kannan S, Schulz A, Israel B, Ayra I, Weir S, Dvonch TJ, Rowe Z, Miller P, Benjamin A. A community-based participatory approach to personalized, computer-generated nutrition feedback reports: the healthy environments partnership. Prog Community Health Partnersh 2008; 2:41-53. [PMID: 19337572 PMCID: PMC2662605 DOI: 10.1353/cpr.2008.0004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Computer tailoring and personalizing recommendations for dietary health-promoting behaviors are in accordance with community-based participatory research (CBPR) principles, which emphasizes research that benefits the participants and community involved. OBJECTIVE To describe the CBPR process utilized to computer-generate and disseminate personalized nutrition feedback reports (NFRs) for Detroit Healthy Environments Partnership (HEP) study participants. METHODS The CBPR process included discussion and feedback from HEP partners on several draft personalized reports. The nutrition feedback process included defining the feedback objectives; prioritizing the nutrients; customizing the report design; reviewing and revising the NFR template and readability; producing and disseminating the report; and participant follow-up. LESSONS LEARNED Application of CBPR principles in designing the NFR resulted in a reader-friendly product with useful recommendations to promote heart health. CONCLUSIONS A CBPR process can enhance computer tailoring of personalized NFRs to address racial and socioeconomic disparities in cardiovascular disease (CVD).
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Affiliation(s)
- Srimathi Kannan
- University of Massachusetts, Department of Nutrition, University of Massachusetts, Boston, MA, USA
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Schulz AJ, Gravlee CC, Williams DR, Israel BA, Mentz G, Rowe Z. Discrimination, symptoms of depression, and self-rated health among african american women in detroit: results from a longitudinal analysis. Am J Public Health 2006; 96:1265-70. [PMID: 16735638 PMCID: PMC1483853 DOI: 10.2105/ajph.2005.064543] [Citation(s) in RCA: 300] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Our understanding of the relationships between perceived discrimination and health was limited by the cross-sectional design of most previous studies. We examined the longitudinal association of self-reported everyday discrimination with depressive symptoms and self-rated general health. METHODS Data came from 2 waves (1996 and 2001) of the Eastside Village Health Worker Partnership survey, a community-based participatory survey of African American women living on Detroit's east side (n=343). We use longitudinal models to test the hypothesis that a change in everyday discrimination over time is associated with a change in self-reported symptoms of depression (positive) and on self-reported general health status (negative). RESULTS We found that a change over time in discrimination was significantly associated with a change over time in depressive symptoms (positive) (b=0.125; P<.001) and self-rated general health (negative) (b=-0.163; P<.05) independent of age, education, or income. CONCLUSIONS The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education.
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Affiliation(s)
- Amy J Schulz
- Department of Health Behavior and Health Education at the University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Israel BA, Parker EA, Rowe Z, Salvatore A, Minkler M, López J, Butz A, Mosley A, Coates L, Lambert G, Potito PA, Brenner B, Rivera M, Romero H, Thompson B, Coronado G, Halstead S. Community-based participatory research: lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research. Environ Health Perspect 2005; 113:1463-71. [PMID: 16203263 PMCID: PMC1281296 DOI: 10.1289/ehp.7675] [Citation(s) in RCA: 322] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 06/13/2005] [Indexed: 05/04/2023]
Abstract
Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities--and communities more broadly--and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children's Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children's health.
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Affiliation(s)
- Barbara A Israel
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Lewis TC, Robins TG, Joseph CLM, Parker EA, Israel BA, Rowe Z, Edgren KK, Salinas MA, Martinez ME, Brown RW. Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach. J Urban Health 2004; 81:472-88. [PMID: 15273269 PMCID: PMC3455945 DOI: 10.1093/jurban/jth131] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Parker EA, Israel BA, Williams M, Brakefield-Caldwell W, Lewis TC, Robins T, Ramirez E, Rowe Z, Keeler G. Community action against asthma: examining the partnership process of a community-based participatory research project. J Gen Intern Med 2003; 18:558-67. [PMID: 12848839 PMCID: PMC1494884 DOI: 10.1046/j.1525-1497.2003.20322.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA's Steering Committee (SC) to design and implement the project. OBJECTIVE To conduct a process evaluation of the CAAA community-academic partnership. DESIGN In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING Community setting in Detroit, Michigan. PARTICIPANTS Twenty-three members of the CAAA SC. MEASUREMENTS Common themes identified by SC members relating to the partnership's ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners' influence in decision-making, the need to adjust to "a different way of doing things" in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.
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Affiliation(s)
- Edith A Parker
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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