This paper discusses the historical context and current challenges of obesity prevention and control initiatives in Texas to understand how the obesity epidemic has been addressed by multiple interacting stakeholders over the past decade. By reviewing state reports and interviewing key decision makers, this paper chronicles recent efforts in Texas by highlighting health policy initiatives and champions who helped to create the foundation for obesity prevention and control. The findings outline the sentinel policy approaches that were implemented by public/private sector partnerships over the last decade, as well as the public figures that have been singular champions in creating the momentum for these changes. The efforts to address obesity with a collaborative approach in Texas have shown initial promise in creating a tipping point to control the obesity epidemic. These strategies can also serve as a model for obesity prevention and control at the national level.
In response to substance abuse within their community, the Alexis Nakota Sioux Nation invited the University of Alberta (UofA) to partner in a collaborative effort to establish a school-based substance abuse prevention program.
An evidence-based substance abuse prevention program was reviewed and adapted by the community to ensure that it incorporated their cultural beliefs, values, language, and visual images. The adapted program was delivered to students at Alexis Nakota Sioux Nation School and changes in student participants' knowledge, attitudes, refusal skills, and self-beliefs were measured. Benefits and challenges of adapting the program were documented.
The principles of community-based participatory research (CBPR) and the Canadian Institute for Health Research, Guidelines for Research Involving Aboriginal People, provided a frame of reference for the work throughout the research process. A pre-/posttest questionnaire was used to measure changes in student participants' drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use. Focus groups (FGs) documented community members' experiences of and responses to the program adaptations and delivery.
Results included (1) positive changes in students' drug and alcohol refusal skills, self-beliefs, and knowledge of the negative effects of drug and alcohol use, (2) ownership of and investment in the program by the community, (3) teaching approaches that correspond with the learning contexts, worldview, and relationships of the community, and (4) participation of community Elders.
Quantitative and qualitative measures provide evidence for the importance, benefits, and challenges of employing a culturally adapted evidence-based substance abuse prevention program with Aboriginal students attending a First Nations school.
National growth in translational research has increased the need for practical tools to improve how academic institutions engage communities in research.
One used by the Colorado Clinical and Translational Sciences Institute (CCTSI) to target investments in community-based translational research on health disparities is a Community Engagement (CE) Pilot Grants program. Innovative in design, the program accepts proposals from either community or academic applicants, requires that at least half of requested grant funds go to the community partner, and offers two funding tracks: One to develop new community-academic partnerships (up to $10,000), the other to strengthen existing partnerships through community translational research projects (up to $30,000).
We have seen early success in both traditional and capacity building metrics: the initial investment of $272,742 in our first cycle led to over $2.8 million dollars in additional grant funding, with grantees reporting strengthening capacity of their community- academic partnerships and the rigor and relevance of their research.
Background: A rural community–academic partnership was developed in 1997 between the Eastern Shore Area Health Education Center (ESAHEC) and the University of Maryland School of Medicine’s (UMSOM) Office of Policy and Planning (OPP). The model supports partnered research, bidirectional interactions, and community and health professional education.
Objectives: The primary aim was to develop a sustainable community–academic partnership that addressed health and social issues on the rural Eastern Shore.
Lessons Learned: Mutual respect and trust led to sustained, bidirectional interactions and communication. Community and academic partner empowerment were supported by shared grant funds. Continual refinement of the partnership and programs occurred in response to community input and qualitative and quantitative research.
Results: The partnership led to community empowerment, increased willingness to participate in clinical trials and biospecimen donation, leveraged grant funds, partnered research, and policies to support health and social interventions.
Conclusions: This partnership model has significant benefits and demonstrates its relevance for addressing complex rural health issues. Innovative aspects of the model include shared university grants, community inclusion on research protocols, bidirectional research planning and research ethics training of partners and communities. The model is replicable in other rural areas of the United States.
Most community-based participatory research (CBPR) projects involve local communities defined by race, ethnicity, geography, or occupation. Autistic self-advocates, a geographically dispersed community defined by disability, experience issues in research similar to those expressed by more traditional minorities.
We sought to build an academic-community partnership that uses CBPR to improve the lives of people on the autistic spectrum.
The Academic Autistic Spectrum Partnership in Research and Education (AASPIRE) includes representatives from academic, self-advocate, family, and professional communities. We are currently conducting several studies about the health care experiences and well-being of autistic adults.
We have learned a number of strategies that integrate technology and process to successfully equalize power and accommodate diverse communication and collaboration needs.
CBPR can be conducted successfully with autistic self-advocates. Our strategies may be useful to other CBPR partnerships, especially ones that cannot meet in person or that include people with diverse communication needs.
The development, implementation, and effective use of community–academic health center partnerships continues to be a most significant and challenging issue, with vast implications for the health of the public, medical education, research, and patient care. Considerable past research and policy proposals addressed this issue. They provided examples of how mutually developed community–academic health centers are instrumental to improving the health and functional status of communities in need.1–4 Simultaneously, the academic health center has benefited from enhanced community support, use of community resources, and the bringing of community-based participatory approaches into medical education, research, and patient care. Despite this, Boutin-Foster, Palermo, Phillips-Caesar, and associates5 forcefully and appropriately reminds us that much work needs to be done to achieve the full benefit of community–academic health center partnerships. This article highlights that although, "Academic health centers and community organizations are structurally and philosophically different, they share a common mission, which is to provide a greater public good."
The authors present informative examples from their work, demonstrating the mutual benefit to communities and academic health centers of a true partnership approach. Of particular note is their model, "The Harlem Community and Academic Partnership (HCAP), a diverse partnership of community residents, community-based organizations and service providers, academia, and public health institutions." This partnership utilized the principles of community-based participatory research to develop initiatives that mutually benefit both the community and the academic health center in regard to community enhancement, improved health care, medical education, and research at the community level. Medical and public health students are now gaining important clinical and research experience in the community. Community members and academic partners launched novel community-based research studies. Research projects hired community members as liaisons, addressing major problems such as obesity among women of color. Academia and specific communities developed increased linkages and partnerships in order to prioritize health issues so they could be mutually addressed.
This article, furthermore, emphasizes the beneficial contributions of a community-based participatory model and the role of community health workers, community leaders, and organizations. Simultaneously, the authors remind us that there are continuing barriers to further development and dissemination of the community–academic medical center model. Among these are continuing skepticism by communities of the depth and sustainability of these partnerships by the academic health center, and skepticism by the academic health center of this type and degree of community involvement, and the implication of this for scholarship, training, and research. To address this, the authors conclude that a paradigm shift is necessary for academic health centers, in which they add another fundamental component to their mission-building strong community partnerships. This effort would be a strategic goal.
The authors are to be complemented for this work and the conclusions they present. A community–academic center approach is fundamental to addressing continuing disparities in health care in the United States. The majority of academic health centers are physically located in communities with excess premature morbidity, disability, and mortality. Although our current academic health centers were frequently founded to and have historically committed themselves to addressing the health care of communities and populations most in need, a community–academic center model has much to offer to enhance this societal role.
1. Remington RD, Axelrode D, Bingham E, Boyle J, Breslow L, Citrin T. et al. The future of public health. Washington, DC: Committee for the Study of the Future of Public Health, Division of Health Care Services Institute of Medicine, National Academy Press; 1988. Institute of Medicine Publication 88-102.
2. Health Professions Education for the Future. Schools in service to the nation. San Francisco: Pew Health Professions Commission;1993.
3. Miles SH, Lunie N, Fisher ES, Hauger ID. Academic health centers and academic reform. Acad Med 1993;68:648–53.
4. Levine DM, Becker DM, Bone LR, Hill MN, Tuggle II MB, Zeger SL. Community-academic health center partnerships for undeserved minority populations: One solution to a national crisis. JAMA 1994;272:309–11.
5. Boutin-Foster C, Palermo AG, Phillips-Caesar E, Boyer A, Love G, Fortin P, et al. The role of community–academic partnerships: Implications for medical education, research, and patient care. Progress in Community...
Americans can combat overweight (OW) and obesity by eating unprocessed, fresh foods. However, all Americans do not have equal access to these recommended foods. Low-income, minority, urban neighborhoods in particular often have limited access to healthy resources, although they are vulnerable to higher levels of OW and obesity.
This project used community-based participatory research (CBPR) principles to investigate the food needs of residents and develop a business plan to improve access to healthy food options in an urban, Kansas City, Kansas, neighborhood.
Partner community organizations were mobilized to conduct a Community Food Assessment survey. The surveys were accompanied by flyers that were part of the communication engagement strategy. Statistical analysis of the surveys was conducted. We engaged low-income, minority population (40% Latino, 30% African American) urban communities at the household level.
Survey results provided in-depth information about residents' food needs and thoughts on how to improve food access. Results were reported to community members at a town hall style meeting.
Developing a strategic plan to engage a community and develop trust is crucial to sustaining a partnership particularly when working with underserved communities. This project demonstrates that, if well managed, the benefits of academic and community partnerships outweigh the challenges thus such relationships should be encouraged and supported by communities, academic institutions, local and national government, and funders.
A CBPR approach to understanding an urban community's food needs and opinions is important for comprehensive food access planning.
This paper argues that it is necessary to strengthen Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) community-based participatory research (CBPR) models that integrate a health policy agenda through dynamic legislative partnerships.
We utilize a case study approach and examine three health research partnership models that impact legislative design and action: The California Program on Access to Care (CPAC), the California Health Benefits Review Program (CHBRP), and the University of California Asian American and Pacific Islander Policy Multicampus Research Program (UC AAPI Policy MRP).
In-depth examination reveals the difficulties of engaging in research that collaborates with multiple parties simultaneously and the specific benefits and challenges in each case.
New directions are needed to deepen legislative engagement potential in CBPR and the translation of policy research that considers the health of all AA and NHPI communities.
Our nation's health is challenged by the persistence of health disparities, lack of universal health insurance, and increasing poverty rates. There is an unprecedented contrast between the sophisticated technology used to treat strictly "medical" conditions and the tools needed to treat problems such as obesity, substance abuse, and domestic violence, which are deeply rooted in social conditions.1 Even when the knowledge base exists regarding how to treat these conditions, a gap exists in how these services are translated to the individual patient and communities as a whole. This gap is being addressed in a number of ways. Accrediting bodies at the undergraduate and graduate levels now require that community health and cultural competency be incorporated into training. Recently, the Liaison Committee on Medical Education recommended that "medical schools should make available sufficient opportunities for medical students to participate in service-learning activities."2 In support of such training initiatives, federal agencies and private foundations have been promoting translational research, service learning, community-based participatory research (CBPR), and community-engaged scholarship in the health care professions. Despite these efforts, training still occurs mostly within hospital walls. Furthermore, many academic institutions remain resistant to viewing community-based education, research, and service as a credible and valid way to address the issues at hand. Community–academic partnerships, for the most part, stem from either individual, passionate leaders or the political need of a particular institution rather than being universally held as an integral part of the mission of an academic medical center.
In this issue of the Progress in Community Health Partnerships, we can learn from two successful initiatives geared towards creating a health care work force that can effectively combine knowledge with action to achieve social change to improve health outcomes and eliminate health disparities.3
Doctor Earnestine Willis and her colleagues describe a successful, sustainable, integrated program for pediatric residents where the community has active participation in the design, implementation, and evaluation of the pediatric training program.4 The tension between creating community projects that meet the self-identified needs of the community and the outside perceived needs of the academic institution seems to be resolved. Both community and university members learn from each other's culture; the learning is reciprocal. The use of parent trainers, described in this article, is of utmost importance in ensuring that health professionals are always in tune with the patient and community perspectives.
In Dr. Debbie Salas-Lopez and her co-worker's article, there is an important attempt to understand health beliefs regarding cancer screening among Latinos, a group that suffers from lower screening rates even though the incidence of some cancers is higher than in the general population.5 Learning the patient's perspective is an essential first step when addressing the differential diagnosis of perceived patient nonadherence.6 Health care providers, and especially trainees, frequently get frustrated when patients do not follow their advice. They rarely take a step back to reflect on why this is the case. Running focus groups with patients or community members can inform providers about the barriers patients and communities face with recommended medical treatments. Issues of culture, language, health literacy, and socioeconomic constraints need to be addressed if we want our interventions to have a meaningful effect. With most visits limited to a 15-minute encounter, we need to develop tools that physicians-in-training can use to elicit the information needed. Studies such as Dr. Salas-Lopez and associate's are a step toward understanding and defining the types of skills that these physician-trainees need to learn to accomplish this.
Many challenges arise when incorporating community– academic partnerships into graduate medical education. Communities are at different developmental stages with regard to their resources, knowledge of health threats, and ability to overcome the historical mistrust existing between them and their neighboring academic center. Community agencies have to be willing to use their manpower in the training of physicians and to dedicate time to CBPR when traditionally they are service driven.
Universities have different levels of commitment to their surrounding community. Financial pressures have institutions abandoning this commitment when funding streams and prestige favor bench side research. Academic medical centers need to be willing...
Process evaluation of community-academic partnership function and fidelity to principles of community-based participatory research (CBPR) is essential to achievement of intermediate and long term partnership goals.
This article describes the evaluation of B Free CEED, a community-academic partnership created to address hepatitis health disparities in Asian American and Pacific Islander (API) communities.
A mixed methods approach with an online survey and qualitative key informant interviews was conducted with all partnership members at baseline and follow-up, 18 months later.
Survey findings showed stability over time, with some consistent differences in community and academic perspectives. Academic members were somewhat more satisfied with the partnership functioning. Key informant interviews provided contextual data key to further defining partnership functioning.
Conducting ongoing partnership evaluations is necessary to reassess and align processes and protocols to enhance partnership functioning and strengthen group cohesion.
• To partner with grass roots organizations in a low-income, minority, urban community, to develop a business plan to improve access to healthy foods.
• This was done by engaging residents in community conversations and conducting a Community Food Assessment Survey, and using the data to drive the development of strategies to improve food access.
• Overweight and obesity levels are at epidemic proportions in the United States. Eating healthy, unprocessed foods such as fruits, vegetables, and whole grains is one way to combat obesity.
• Studies indicate that Americans who live in underserved, low-income, minority communities have poor access to nutritious, fairly priced, high-quality foods.
• It becomes difficult for residents of such communities to follow recommended dietary guidelines, thus increasing their risk of obesity and other conditions such as diabetes and cardiovascular disease.
• Community-based participatory research approaches are increasingly being used to solve community food access issues.
• Residents are unanimously dissatisfied with the lack of a full-service grocery store in Argentine and chose the introduction of a grocery store as their top solution to food access issues in the community.
• On average residents spend $104 per week for a five-person household.
• On average residents had to go 3.5 to 5 miles to access the nearest full-service grocery stores, making Argentine a food desert.
• An unexpectedly low percentage (10.6%) of residents surveyed reported being on the Federal Women, Infants and Children program. However 35.7% reported being on the Supplemental Nutrition Assistance Program.
• Eighty percent of residents reported shopping at least weekly or more with 11% shopping for a household other than their own.
• Although ratings of food quality at stores frequented were high, fruit and vegetable consumption was low owing to prohibitive costs and personal preferences.
• Residents admitted to resorting to fast food establishments as a cheap way to feed their families.
• Community-based organizations and community health centers.
• Residents of underserved, low-income, minority urban and rural communities.
• Food policy makers.
• Chain and independent grocery stores.
• Communities addressing food access issues should conduct culturally tailored comprehensive community food assessments to avoid wasted time on strategies that do not match the population's needs or desires.
• Community organizations should consider partnering with experts from other organizations in various sectors, including academic, financial, government, and nongovernmental agencies, to help them address food access issues.
• More planning grants should be made available to communities to increase the probability of success at the implementation stage.
Community-based participatory research (CBPR) approaches equitably involve community members and researchers throughout the research process. A developing literature examines problems in CBPR partnerships, but less is written about community groups using CBPR to access university resources to address community-prioritized health concerns.
We sought to examine issues in two stages of a National Institutes of Health (NIH)-funded CBPR partnership: (1) joint proposal preparation, and (2) grant administration.
We used a case study approach to analyze data (partner dialogs, meeting notes, interviews, and press coverage) from a longstanding community-academic partnership.
The partnership received NIH Partners in Research Program funding. During joint proposal preparation, issues included (1) learning to practice operating principles, such as "talking in ways that all people can understand," (2) streamlining proposal design to facilitate communication with community members, and (3) addressing inequities inherent in community-academic budget sharing. During the administration phase, issues included (1) community partner struggles with administrative requirements, (2) inequities in indirect cost (IDC) allocations, and (3) the impact of a natural disaster.
Separately funded CBPR grants can contribute to community partner development, but make substantive demands on small, grassroots community organizations. Funders should consider taking more responsibility in developing community resources and infrastructure to ensure that grassroots community groups have the power to be equal partners. More accurate accounting of costs and benefits of CBPR to vulnerable communities should be in place to ensure communities receive adequate return on the time they invest in partnering with universities.
Although academic institutions are rich resources for improving public health, academic partnerships with community organizations can be challenging. We describe a successful academic-community partnership composed of the Dartmouth Toxic Metals Research Program, the Manchester (New Hampshire) Health Department, and the Greater Manchester Partners Against Lead Poisoning (GMPALP).
Partners collaborated to translate science and best practices into social action and policy change to address childhood lead poisoning.
Using the evolution of a childhood lead poisoning prevention initiative, we discuss how an academic-community relationship can be created and sustained.
Our experience demonstrates that broad-based partnerships are enhanced by the attributes of community-based participatory research (CBPR). We observe that engaging in community collaborations that are not driven by research eliminates potential conflicts for academic and community partners.
We identify four core values, namely, (1) adaptability, (2) consistency, (3) shared authority, and (4) trust, as being constructive when working in such partnerships.
Community-academic partnerships are an increasingly popular approach to addressing community health problems and engaging vulnerable populations in research. Despite these altruistic foci, however, partnerships often struggle with fundamental issues that thwart sustainability, effectiveness, and efficiency.
We adapted a synergy-promoting model to guide the development and evaluation of a community-academic partnership and share lessons learned along the way.
We analyzed the partnership process over time to determine the interaction of trust, collaboration, and engagement in creating partnership synergy and promoting sustainability.
Few community-academic partnerships use a conscious and systematic approach to guide and evaluate their progress. We argue that this is an important first step in creating a partnership, sustaining a milieu of open dialogue, and developing strategies that promote trust and equalize power dynamics. Still, as we learned, the best laid plans can go awry, challenging partnership synergy throughout its lifespan.
The potential for academic community partnerships are challenged in places where there is a history of conflict and mistrust. Addressing Disparities in Asian Populations through Translational Research (ADAPT) represents an academic community partnership between researchers and clinicians from Tufts Medical Center and Tufts University and community partners from Boston Chinatown. Based in principles of community-based participatory research and partnership research, this partnership is seeking to build a trusting relationship between Tufts and Boston Chinatown.
This case study aims to provides a narrative story of the development and formation of ADAPT as well as discuss challenges to its future viability.
Using case study research tools, this study draws upon a variety of data sources including interviews, program evaluation data and documents.
Several contextual factors laid the foundation for ADAPT. Weaving these factors together helped to create synergy and led to ADAPT's formation. In its first year, ADAPT has conducted formative research, piloted an educational program for community partners and held stakeholder forums to build a broad base of support.
ADAPT recognizes that long term sustainability requires bringing multiple stakeholders to the table even before a funding opportunity is released and attempting to build a diversified funding base.
Filipino Americans have more adolescent pregnancies than other Asian-Pacific Islanders (APIs). Few community-academic collaborations have addressed adolescent pregnancy prevention in this community.
We sought to describe the lessons learned from and impact of a community-based teen pregnancy prevention program for Filipino Americans implemented by a Filipina pediatrics resident.
We formed a community-academic partnership between the Filipino Youth Coalition, a community-based organization (CBO) in San Jose, California, and the Stanford School of Medicine's Pediatric Advocacy Program. We developed a culturally tailored parent-teen conference addressing adolescent pregnancy prevention in Filipino Americans. We qualitatively and quantitatively evaluated this intervention by collecting both pre- and post-conference data using a convenience sample design.
Engaging particular aspects of Filipino culture (i.e., religion and intergenerational differences) helped to make this community-academic partnership successful. For physicians-in-training who are conducting community-based participatory research (CBPR), project challenges may include difficulties in building and maintaining academic- community relationships, struggles to promote sustainability, and conflicting goals of "community insiders" and "academic outsiders." Authors offer insights and implications for residents interested in practicing CBPR.
CBPR is a key tool for exploring health issues in understudied populations. CBPR experiences can provide meaningful educational opportunities for physicians-in-training and can build sustained capacity in CBOs. They can also help residents to develop analytic skills, directly affect the health of the communities they serve, and, for minority physicians, give back to the communities they call home.
We present a model of a community-academic partnership formed to replicate a unique salon-based health education and promotion program among African-American and Latino communities in Philadelphia.
The purpose of this article is to describe the partnership principles established and lessons learned in replicating the salon-based program that sought to develop a cadre of community-academic partners and build community-based organizations' (CBOs) capacity to implement and evaluate the program.
As the lead organization, the Arthur Ashe Institute for Urban Health (AAIUH), formed a partnership with two CBOs, three universities, and 17 salons. Guiding principles were established to manage the large collaborative and ensure success.
By embracing a common mission and principles of understanding, co-learning, building capacity and sharing responsibility and recognition, this partnership was able to achieve positive outcomes. Challenges faced were related to replication, CBO infrastructure, data management capacity, and other process issues.
Despite challenges, we created and sustained an enduring partnership and brought positive change to the community. Lessons learned highlight issues to examine before furthering this work such as fostering trust and building meaningful relationships.
Despite several studies demonstrating the benefits of community-academic partnerships, their value to academic health centers (AHCs) is often viewed with skepticism by some in the academic community.
This paper examines the roles of community organizations and the mechanisms by which they can enhance the AHC missions of education, research, and patient care.
As lay educators, community organizations can contribute to medical education by exposing students to diverse cultural perspectives. As community advocates, they can facilitate the research process by helping to frame culturally relevant research questions, by ensuring that research survey instruments are culturally and linguistically appropriate, and that research findings are disseminated to community stakeholders. As lay health workers, they can facilitate health care delivery by providing a link to hard-to-reach populations through their outreach and referral initiatives.
Forming partnerships between community organizations and AHCs can support the missions of AHCs and simultaneously develop and strengthen community capacity.
Individuals with serious mental illnesses (SMI) represent a high-risk health disparities population disproportionately affected by diabetes and obesity.
Objectives: This paper describes a community-based participatory research (CBPR) approach to adapting a well-known evidence-based behavioral change protocol, the Diabetes Prevention Program (DPP) lifestyle intervention, for individuals with diabetes and SMI in the community setting.
Methods: A committee composed of university researchers and representatives from the recovery community modified the DPP following three criteria: Person centeredness, practicality, and empowerment.
Lessons Learned: Major modifications to the DPP were made in light of barriers and challenges faced by individuals with diabetes and SMI.
Conclusions: The adaptations made to the DPP, and the process through which the modifications were made, may be used by physicians, mental health practitioners, and health educators to engage individuals confronting self-management of diabetes and mental illness.
Community participation in population health improvement can assist university researchers in targeting intervention resources more effectively and efficiently, leading to more effective implementation of interventions, because of joint ownership of both process and product. Two academic health centers partnered with community based organizations to develop a bidirectional educational seminar series called "Community Grand Rounds" (CGR), which identified health concerns of Chicago's South Side residents and provided information regarding university and community resources that addressed community health concerns.
We evaluated the community consultants' perceptions of the quality and effectiveness of the planning and implementation of the seminars that resulted from the partnership.
We conducted one-on-one interviews and focus groups with community consultants to assess their perceptions of the partnership using a tailored version of a previously developed individual and focus group interview instrument. Analysis of the interview text was conducted using grounded theory where themes were coded as they emerged.
CGR is an effective mechanism for providing needed community health information in an easily accessible format. Additional work is needed to determine whether this format represents a sustainable community-university partnership.
The New York University- New York City Health and Hospitals Corporation (NYU-HHC) Clinical and Translational Science Institute (CTSI) used a community-based participatory research (CBPR) and consensus-building approach among its community advisory board (CAB) and steering committee (SC) members to formulate research priorities to foster shared research collaborations.
The Delphi technique is a methodology used to generate consensus from diverse perspectives and organizational agendas through a multi-method, iterative approach to collecting data. A series of on-line surveys was conducted with CAB members to identify health and research priorities from the community perspective. Subsequently, CAB and SC members were brought together and the snow card approach was utilized to narrow to two priority areas for shared research collaborations.
Cardiovascular disease (CVD)/obesity and mental health were identified as health disparity areas for shared research collaborations within a social determinants framework. In response, two workgroups were formed with leadership provided by three co-chairs representing the three constituents of the NYU-HHC CTSI: NYU faculty, HHC providers, and community leaders
The Delphi approach fostered ownership and engagement with community partners because it was an iterative process that required stakeholders' input into decision making. The snow card technique allowed for organizing of a large number of discrete ideas. Results have helped to inform the overall CTSI research agenda by defining action steps, and setting an organizing framework to tackle two health disparity areas. The process helped ensure that NYUHHC CTSI research and community engagement strategies are congruent with community priorities.
To decrease the gulf between academic and community perspectives, there has been an increased call among stakeholder groups to collaborate in solving complex urban health problems. Despite these recent shifts, however, community partners face barriers to participate in conferences, ultimately limiting exchange of ideas and uptake of research data. This paper reports on the evaluation of the strategy used to engage community participants at the 4th International Conference on Urban Health (ICUH) held in Toronto, Canada, in October, 2005.
We surveyed participants (n = 98) and conducted follow-up interviews (n = 23) to assess factors that facilitated attendance at ICUH 2005 as well as the impact of the conference on their work.
Community registrants were drawn by accessible fee structures, scholarship opportunities, and preconference workshops relevant to their interests. Both community and academic registrants were drawn by the presence of a separate conference stream showcasing high-quality and rigorous community-based participatory research (CBPR). The conference provided valuable opportunities for networking with other community-based researchers by facilitating the development of relationships between community registrants and researchers, increased the profile and legitimacy of CBPR, and reinforced the value of community input in research. It also provided opportunities for capacity building-knowledge sharing and heightened awareness of CBPR.
The 4th ICUH had a significant impact on community registrants and provided valuable opportunities to bridge academic and community divides. These data support the need for comprehensive strategies for community engagement at health conferences.
Community-based participatory research (CBPR) requires equitable partnerships between community stakeholders and academics. Traditionally, researchers relied on community advisory boards, but these boards often play a reactive role limited to a project-by-project basis. The East and Central Harlem Health Outcomes (ECHHO) Community Action Board (CAB), however, is an effective, proactive group.
The ECHHO board sought to identify key strategies and tools used to build and sustain the model, and to disseminate lessons learned to other community-academic partnerships.
Current and former board members were interviewed and a wide range of related documents was reviewed.
The board became effective when it prioritized action and relationship-building, across seven key domains: Shared priorities, diversity, participation, transparency, mutual respect and recognition, and personal connections. The model is depicted graphically.
Community advisory boards may benefit from reduced emphasis on protocols and procedures, and increased attention to building relationships between academics and community members.
In Florida, data reveal a widening black-white disparity in infant mortality to the disadvantage of black families. Eight Florida counties have a significantly pronounced black-white infant mortality gap: Broward, Duval, Gadsden, Hillsborough, Miami-Dade, Orange, Palm Beach, and Putnam.
The black Infant Health Community Collaborative (BIHCC) was established to address the rising racial/ethnic disparities in infant mortality. The program used a community-based participatory research (CBPR) approach to enable communities to develop sustainable initiatives to improve community health and reduce infant mortality.
Grounded in CBPR principles, a community-academic-state partnership was created to address the upsurge in black-white disparity in infant mortality. Community teams from each participating county underwent a 2-year period of capacity building. The culmination of this process was community-driven action plans to alleviate infant health disparities.
The BIHCC provides a replicable model for the development of community-academic-state partnerships to enhance capacity for improving infant health outcomes.
In developing countries, the most accessible source of treatment for common conditions is often an informal drug shop, where drug sellers are untrained and operations are unmonitored.
We sought to describe a public-private initiative in Tanzania that created a new class of provider in government-accredited drug outlets, which improved the quality of medicines and pharmaceutical services in previously underserved areas.
The accredited drug-dispensing outlet program combines changing behavior and expectations of community members who use, own, regulate, and work in drug shops. Success resulted from including community stakeholders from the beginning of the process.
Addressing shortages in qualified health care providers by training and accrediting private sector drug dispensers to recognize common conditions and provide quality pharmaceutical products and services is feasible in a developing country, when supported by an appropriate policy and regulatory environment. Scaling up and sustaining the program will be a challenge.
Violence is a leading cause of death and disability for U.S. youth. The U.S. Centers for Disease Control and Prevention (CDC)'s Division of Violence Prevention (DVP) is committed to developing communities' capacity to engage in evidence-based youth violence (YV) prevention.
We discuss the characteristics of communities that exert influence on the development and epidemiology of YV, and discuss opportunities for how community-research partnerships can enhance efforts to prevent violence in communities.
The needs for YV prevention are unique; the nature and phenomenology of violence are community specific. Communities also vary widely in infrastructure and systems to support coordinated, evidence-based YV prevention strategies. These conditions highlight the need for community-research partnerships to enhance community capacity, employ local resources, and engage community members in the research process.
DVP is committed to working towards creating communities in which youth are safe from violence. Approaches to YV prevention that emphasize community-research partnerships to build capacity and implement evidence-based prevention strategies can provide a supportive context for achieving that goal.
The St. Louis Komen Project was conceived to address disparities in breast cancer treatment and outcomes between African-American and White women in St. Louis, Missouri. Our goal was to apportion tasks and funding through a process to which all researcher partners had input and to which all could agree, thus eliminating institutionalized inequalities.
This paper describes the collaborative process and resulting division of responsibilities, determination of costs, and ultimate allocation of funds and resources, as well as the documentation employed to achieve funding reciprocity and equal accountability.
Both communication and documentation are critical. Although the Memoranda of Understanding employed are not a panacea, they codify roles and expectations and promote trust. The process of developing financial transparency set the tone for subsequent steps in the research process.
The exhaustive planning process and project-specific procedures developed by its partners have helped the project foster reciprocity, facilitate participation, and equitably distribute resources.
• To chronicle and evaluate the community-based research process used in the development of the Community Learning Centres (CLCs) in rural Canadian communities, specifically Aboriginal communities. In particular, this study considers culturally and geographically relevant health information while focusing on the process of building relationships among the partners as well as the value and sustainability of the CLC model.
• Many rural Canadian communities, especially Aboriginal communities, have inadequate access to geographical or socially relevant health information, which has detrimental impacts on community members’ health and well-being.
• Little research exists on implementing and evaluating CLCs in Aboriginal communities as a way of addressing the lack of culturally and geographically suitable health and social service information.
• The analysis of interviews revealed four themes: People with different cultural backgrounds finding ways to work together, project employees taking ownership over and a lead in the project’s success, community leads who coordinated CLCs gaining technical and research skills, and the university team learning about collaborative research in Aboriginal communities.
• Participants identified several process challenges, including working out how to run the project cooperatively, negotiating different working styles, and hiring people who were committed to the success of the project.
• Having a CLC in the community made it possible for community members to learn about health information and further the progress of other community initiatives.
• Health care practitioners, including nursing, medical, and allied health and social service professionals.
• Rural community development officers and/or researchers.
• Aboriginal health care programs.
• Aboriginal and Canadian Governments.
• Meet all partners “where they are” in building trusting relationships and adapting research methods to fit the context and strengths of the project.
• Include a joint university–community training session or facilitated discussion to become familiar with both university and community protocols to initiate the process of comparing and contrasting community and post-secondary procedures. In addition, create strategies for working through differences, break project into small goals..
• Consider how technological access provided by the CLCs will increase capacity for learning and collective initiatives in the community, as well as the skills, knowledge, and perceived self-efficacy of the community research leads. As such, plan for additional support services, such as information technology training, as capacity and confidence increases in communities.
• Incorporate a hiring rubric matrix where the emphasis is placed on commitment to the project objectives to effectively meet different working styles and levels.
• Plan for turnover in community research staff by including a work plan for alternative research members to maintain responsibility for community-based features of the project.
Tobacco use in Baltimore and other urban areas remains a major public health challenge. Rates of use are high, with 28% of adults in our city reporting smoking in the 2007 behavioral risk factor survey conducted by the Centers for Disease Control and Prevention, compared to a statewide rate of 17%. Other studies have found very high rates of tobacco use among young adults in urban areas, as high as 60% in some subpopulations.1 Tobacco use, of course, also is associated with substantial morbidity and mortality. In Baltimore, over the last seven years, our age-adjusted heart disease mortality has been 30% greater than the rate among Maryland residents, with substantially higher rates among African-Americans.2
Complicating this bleak picture is the fact that some common tobacco control measures may have less than optimal effectiveness in large cities. For example, cessation services may be inaccessible to many without regular sources of health care. Public education campaigns designed for the country or state as a whole may fail to resonate. The myriad corner stores in an urban environment further complicate the task of enforcement. As a result, new research and new ideas are needed to address urban tobacco use.
The paper by Katherine Clegg Smith and her colleagues starts with this critical and understudied challenge.3 It is based on in-depth interviews with 14 senior city officials in government, education, and job training. According to the study, the city leaders believe that young adults in training programs are seeking major change in their lives, but that to date, changing their tobacco use has not been not part of the package. Those interviewed felt that mentorship could be an avenue to help youth quit smoking. They also believe that tobacco control programs aimed at young adults should address the role tobacco has in helping them deal with many stressors in their lives.
These findings should be viewed as preliminary. The number of people interviewed is small, and the researchers do not present data from any interviews with the young adults themselves.
Yet the results suggest an opportunity for intervention that is worth pursuing – building cessation and tobacco prevention education into job training and education programs.
If we can reach young people at a time and place where they are already making changes in their lives, then we may have a chance to have a much greater impact than with more diffuse, citywide efforts alone.
To succeed, such efforts must overcome several obstacles. First, the efforts must integrate tobacco control into the overall approach and message of the training programs. This may require opening up the curricula to add points of discussion and teaching on tobacco. Second, the efforts must overcome any resistance among the teachers and trainers. If addressing tobacco is seen as a hindrance or distraction, it is unlikely that the young people will hear the right message. One of the roadblocks to tobacco control may be that the staff model tobacco use themselves. Third, the efforts must have a message that resonates with young people. I am not persuaded by the fear that tobacco control is impossible until we solve all other urban ills, including poverty, joblessness, and violence. But helping young people see that tobacco use only complicates their own efforts at self-advancement in the face of these challenges could prove to be very important.
It is also critical for researchers to evaluate these efforts. The approach of community-based participatory research embodied by this paper and others by the same research group exemplifies what can be accomplished through creative and inclusive partnerships.
But as these researchers make clear, the end goal is not a publication. If the evaluations of pilot programs are too small to be useful or too long in coming to be relevant, then we will lose critical opportunities to make progress. Unfortunately, there are far too many examples of successful research projects that have never led to substantial health improvements in cities, including Baltimore.
In some cases, this failure has its roots in poor communication between researchers and the policymakers who could provide sustainable support. Engaging the interest of policymakers early and often is an often overlooked part of a sustainability...
African Americans bear an unequal burden of breast, cervical, and colorectal cancer. The Deep South Network for Cancer Control (DSN) is a community-academic partnership operating in Alabama and Mississippi that was funded by the National Cancer Institute (NCI) to address cancer disparities using community-based participatory research approaches.
In addition to reporting on the plans of this work in progress, we describe the participatory process that local residents and the DSN used to identify needs and priorities, and elaborate on lessons learned from applying a participatory approach to the development of a community action plan.
We conducted 24 community discussion groups involving health care professionals, government officials, faith-based leaders, and other stakeholders to identify cancer health disparity needs, community resources/assets, and county priorities to eliminate cancer health disparities. To develop a community action plan, four working groups explored the themes that emerged from the discussion groups, taking into consideration evidence-based strategies and promising community practices.
The DSN formulated a community action plan focusing on (1) increasing physical activity by implementing a campaign for individual-level focused activity; (2) increasing the consumption of fruits and vegetables by implementing NCI's Body and Soul Program in local churches; (3) increasing cancer screening by raising awareness through individual, system, and provider agents of change; and (4) training community partners to become effective advocates.
A community-academic partnership must involve trust, respect, and an appreciation of partners' strengths and differences. The DSN applied these guiding principles and learned pivotal lessons.
The multiple and diverse perspectives, skills, and experiences inherent in community-academic partnerships make them uniquely positioned to educate policy makers and advocate for health equity. Effective communication tools are critical to successfully engage in the policy-making process. Yet few resources emphasize the development and use of practical tools for translating community-based participatory research (CBPR) findings into action. The purpose of this article is to describe a CBPR process for developing and using a one-page summary, or "one-pager," of research findings and their policy implications. This article draws on the experience of the Healthy Environments Partnership (HEP), a community-academic partnership in Detroit, Michigan. In addition to describing these processes, this article includes a template for a one-pager and an example of a one-pager that was written for and presented to federal policy makers.
Principal investigators (PIs) of community-based projects are predominantly university faculty who partner with community-based organizations (CBOs) to find a place to conduct research in communities that will cooperate with their research objectives. University-managed research models (UMRMs) are not always beneficial for CBOs because the university usually manages the study, collects and owns the data, and leverages control at each stage of research, without priority to resolution of problems impacting the quality of life of participating communities.
We present the principles of community-owned and -managed research (COMR), as a new community-driven research model developed by the West End Revitalization Association (WERA), a CBO in Mebane, North Carolina.
We describe WERA's development of COMR, compare the power hierarchies of COMR with traditional UMRMs, distinguish COMR partnerships from UMRM partnerships, discuss disbursement of funds, and control/ownership of data. As the PI of research activities, WERA drafted Memoranda of Agreement (MOAs) for all partners, including academic researchers, implemented quality assurance and control procedures, submitted community research protocols for institutional review, and retained data ownership for action, activism, and problem solving. COMR methods encouraged corrective action of environmental justice (EJ) problems in affected communities, including provision of public, regulated drinking water and sewer services.
COMR promotes CBOs with demonstrated organizational capacity to PI and project manager. The COMR model goes beyond UMRMs and CBPR because it emphasized the credibility and capacity of CBOs to develop, own, manage, foster, and sustain viable research agendas to address ongoing environmental hazards and related threats to health and quality of life.
Brownsville Action Community for Health Equality (BACHE) is a coalition-based, service system change pilot for African American and Puerto Rican women of Brownsville, a community within Brooklyn, New York, with disproportionately high rates of infant mortality.
Identify "lessons learned" from the implementation phase of a 5-year pilot project that employs a community-based participatory (CBPR) approach to reducing risk factors for infant mortality.
Nineteen semi-structured interviews were conducted with BACHE's partners throughout 2010. Sessions were audiotaped and transcribed. Data was incorporated into a framework based on grounded theory and interpreted by project partners.
Lessons learned related to engaging partners, leveraging community resources, dealing with highly structured institutions, measuring progress, and promoting and sustaining system change.
A service system change pilot like BACHE requires: social capital, capable partners, a strong coalition, flexibility of approach, internal champions, systems knowledge, awareness of policy, and strong community involvement.
This article describes the Trauma Healing Project (THP: www.http//healingattention.org), the Survivor Voices study (n = 351), and the complementary nature of community- campus partnerships (CCP) and community-based participatory action research methodology (PAR). Survivor Voices-a random digit telephone survey developed by, conducted, analyzed, and disseminated by survivors of abuse and violence, university researchers, and students-was designed to learn from survivors about what hurt and about what helped with regard to how people responded to their trauma, and what they recommend for trauma healing. We feature our CCP, including challenges faced, how we have addressed those challenges, and profile our current findings. We describe how PAR and CCPs can be very useful tools toward the development of a community-wide effort to reduce violence and support trauma healing.
Rural communities, particularly Aboriginal communities, often have limited access to health information, a situation that can have significant negative consequences. To address the lack of culturally and geographically relevant health information, a community-university partnership was formed to develop, implement, and evaluate Aboriginal Community Learning Centres (CLCs).
The objective of this paper is to evaluate the community-based research process used in the development of the CLCs. It focuses on the process of building relationships among partners and the CLC's value and sustainability.
Semistructured interviews were conducted with key stakeholders, including principal investigators, community research leads, and supervisors. The interview transcripts were analyzed using an open-coding process to identify themes.
Key challenges included enacting shared project governance, negotiating different working styles, and hiring practices based on commitment to project objectives rather than skill set. Technological access provided by the CLCs increased capacity for learning and collective community initiatives, as well as building community leads' skills, knowledge, and self-efficacy. An important lesson was to meet all partners "where they are" in building trusting relationships and adapting research methods to fit the project's context and strengths.
Successful results were dependent upon persistence and patience in working through differences, and breaking the project into achievable goals, which collectively contributed to trust and capacity building. The process of building these partnerships resulted in increased capacity of communities to facilitate learning and change initiatives, and the capacity of the university to engage in successful research partnerships with Aboriginal communities in the future.
This paper describes a school-based youth violence prevention program and challenges encountered during efforts to evaluate it. Members of a community partnership team helped to shape the quantitative and qualitative data collection and to interpret results.
48 youth participants in the violence prevention program completed a survey soliciting information about violence-related risk and protective factors, including employment readiness, school connectedness, association with delinquent peers, and violence-related attitudes, intentions, and behaviors. Fourteen youth also participated in two focus groups about their satisfaction with the violence prevention program.
Through the preliminary data collection process, we learned three key lessons. (1) Institutional Review Boards (IRBs) new to community-based research may need to build capacity to evaluate the human subjects implications of this type of research. (2) The identification of control or comparison groups for school-based youth violence programs may be challenging and costly. (3) Methods for reducing loss-to-follow-up with high-risk youth are needed.
CHIP is more than a means of identifying, prioritizing, and addressing local health needs. At its heart, CHIP is a method by which neighborhoods can self-actualize and attain locally recognized health goals. The process begins with the development of a local coalition that designs and implements health improvement services.1 The definition of the coalition and the processes involved in recruiting, maintaining, and sustaining the group may vary, depending on the size of the jurisdiction in question. In a smaller community or in neighborhoods, the implementation processes of community health improvement may be determined primarily by local constituents who can more closely scrutinize the process and by so doing are more likely to benefit from its results.
Beginning in 2003, RHI, a group of local organizational partners and neighbors interested in health, established a coalition and began to address the need for neighborhood health improvement. Initial coalition partners included local social service agencies, local public schools, a minority health organization, a local medical clinic, a large health system, two academic partners, a university's nursing faculty and its community nursing center, neighborhood residents, and local media. Meetings were open and the coalition grew over time. After meeting for about a year, the coalition used community-based models of action2–5 to expand partnerships, assess the community's health, and begin working toward improved health outcomes. Coached by its academic partners, RHI applied principles of CBPA to implement CHIP1 as a model for facilitating health improvement. For example, RHI members recognized the need for a community health assessment that went beyond readily available epidemiologic data and included social, behavioral, and environmental information.
In this report, the issues the coalition addressed and the processes used to implement the CHIP are described at the level of a local, very urban neighborhood including almost 7,000 households in six census tracts. The community partners found that neighborhood-derived health priorities are more specific than those of larger jurisdictions. CHIP provided local data that helped practitioners to target scarce resources to the specific health concerns of the community.
RHI was designed to establish a stronger ecological link between the Riverwest community and local health services than previously existed. The partners initially came together, and after several round table discussions about their individual agency's missions, found that they all shared common beliefs in primary health care, social justice, and a goal for health improvement. Two theoretical models informed this initiative. The first was derived from the World Health Organization's (WHO) definition of primary health care to which the RHI members subscribed. This is a health promotion model that includes social and environmental determinants of health, community participation, and delivered where people live and work.6
The second model, CBPA, was introduced by the academic partners and provided a means for the RHI coalition to express locally WHO's global ideals. CBPA is an ecological framework grounded in social justice.7,8 For this reason, it is particularly well-suited to public health and has been described widely in the community/public health literature over the past 10 years.9-17 CBPA supports a democratic model of research that provides for a distribution of power that includes community members in the process. From a research standpoint, principles of CBPA include "casting a wide net in recruiting participants and involving them in every step, including project design, implementation, analysis, and dissemination of results."18
From a public health perspective, the principles include (1) recognizing the community as a unit of identity, (2) building on strengths and resources within the community, (3) facilitating collaborative partnerships in all phases, (4) committing to integrating knowledge, and (5) acting for mutual benefit of all partners.13 Throughout, CBPA promotes a co-learning and empowering process that attends to social inequalities. Having been influenced by Brazilian educator Paulo Freire,19 CBPA is an iterative process that includes the broad determinants of health and ensures that the knowledge gained is understandable, respectful, and shared.13 Together these two models grounded the initiative in a research framework with strong health promotion and community perspectives. From the outset, RHI was committed to creating a model that would build on...
The Riverwest Health Initiative (RHI) is a community-based participatory action (CBPA)-driven coalition. The group used several action models to create a community health improvement process (CHIP) uniquely suited for the neighborhood. The issues the coalition addressed and the processes used to inform community health improvement are described at the level of an urban neighborhood, including almost 7,000 households in six census tracts.
Describe the influence of conceptual models of CBPA on the development of a neighborhood CHIP. Demonstrate the effect of integrating CBPA and CHIP in acquiring locally relevant health information.Methods: RHI incorporated resident input in developing a health assessment survey to augment epidemiologic data. The survey allowed neighborhood residents to describe their health status, behaviors, and health care utilization. It included perceptions about neighborhood support and safety, mental and emotional health, and other issues not usually captured in available epidemiologic data.
Based on survey results and an iterative process of community input, residents identified health priorities that were more specific to their community than would have otherwise been available from traditional public health data sources. This information was used to inform the strategic planning process.
The CHIP provided local data that helped practitioners to better target scarce resources to the specific health concerns of the community. Linking the processes of CHIP and CBPA allowed the RHI to be informed in an ongoing manner about the neighborhood's strengths and challenges.
Researchers and community coalition members collected survey data and used it to guide production of an educational video promoting a bicycle-friendly environment.
Telephone and mailed surveys were conducted among bicyclists and motorists for needs assessment.
A sample of 173 bicyclists completed a mailed survey (response rate of 87.0%), and a sample of 801 motorists completed a telephone survey (response rate of 42.1%). Findings guided video production.
Most motorists understood that bicyclists have a right to ride in the road, but about one half believed bicyclists create a hazard, even when they follow traffic laws. Bicyclists expressed safety concerns and felt threatened by motorists. Both motorists' and bicyclists' knowledge of traffic rules varied across the items.
This project illustrates how community members can apply research findings to an educational video of high quality with local relevance. The leadership from community members in making the video set the foundation for local ownership.
Collaboration characterized by mutual capacity building, asset sharing, and tangible outcomes that work to further health equity are central tenets of community-based participatory (CBPR) approaches to research. Such efforts require the establishment, development, and maintenance of trusting relationships between community and institutional stakeholders.
The objective of the strategies discussed here was to strengthen a community-academic partnership by facilitating communication and empowering project partners.
Team-building activities and experiential exercises were intentionally utilized with project stakeholders to clarify roles and responsibilities, provide alternative avenues for authentic communication, and share power.Lessons Learned: Team-building activities can be effective in promoting CBPR partnerships when utilized appropriately. Through the course of the partnership building process, best practices emerged for utilizing experiential learning exercises to enhance partnership dynamics.
Team-building activities provide a useful tool for developing supportive environments that encourage open dialogue.
Adapting mental health interventions to heighten their cultural and contextual appropriateness may be critical for engaging ethnic/racial groups that have been traditionally excluded or marginalized. Community-based participatory research (CBPR) is a collaborative research approach that highlights unique strengths and expertise of those involved. Although intervention adaptations have garnered much attention there is little previous work specifically describing the adaptation process of mental health interventions using CBPR.
This article summarizes the use of a CBPR approach to adapt a mental health intervention for urban adolescents and young adults disconnected from school and work, a population at elevated risk for poor mental health owing to the presence of numerous chronic stressors.
We describe the process undertaken to modify the content and delivery format of an evidence-based intervention.
Unique challenges of working with urban African American adolescents and young adults in a job training program are highlighted. By incorporating principles of co-learning and shared responsibility, this partnership was able to achieve positive outcomes.
Our experience suggests that a CBPR approach can be used effectively to adapt a mental health intervention in collaboration with African American adolescents and emerging adults in a job training program.
With growing use of Community Health Workers (CHWs) to reach underserved populations, there is a need for more information on training methods to prepare CHWs, particularly in a health educator role.
To describe procedures used to recruit, train, and evaluate CHWs in Project Sugar 2, a randomized controlled trial of a nurse case manager and CHW team intervention designed to improve diabetes care and control in a sample of 542 urban African Americans with type 2 diabetes.
CHWs received a Core Training on guidelines and procedures, didactic diabetes self-management education, and research protocol training. However, barriers to CHW implementation of the intervention were encountered, including CHW attrition, job performance and satisfaction issues, low self-confidence in knowledge and skills as educators, difficulties with maintaining a large caseload, and inefficiencies experienced in conducting home visits. To address barriers, the initial training was modified and condensed. A supplemental training utilizing participatory methods was developed collaboratively by CHWs and trainers to facilitate CHWs' designing of intervention materials in their own words and contributing processes for intervention implementation and quality control.
The supplemental training resulted in CHW retention, satisfaction, confidence in skills, and feelings of ownership of the intervention. Participant satisfaction with care received from the CHWs and the Project Sugar 2 intervention was rated as high by 97% and 93% of responders, respectively.
Core training in research intervention policies, procedures, and protocols, combined with an extended participatory training, led to effective preparation of laypersons to serve as CHWs.
Previous studies have shown that environmental burdens tend to be inequitably borne by poor and minority populations. Statistics indicate that these populations suffer disproportionately from adverse health effects associated with polluting facilities in their community. To address these problems, public health officials and researchers should pay close attention to the experiences of individuals in local communities.
The aims of the Community-Based Internship Program were to (1) provide a graduate internship that gives students the opportunity to utilize their didactic skills in a community-based setting on important environmental issues and (2) educate and empower the community with the tools needed to address their environmental concerns and protect their health. Graduate students from various disciplines participated in a 12-week internship program that involved community-based organizations (CBOs) working on environmental health and justice issues.
A total of 22 graduate interns were given projects that assisted the CBOs in creating environmental health awareness and educating communities about environmental issues. Each internship represented a unique partnership between a university, an environmental law firm, and CBOs. This equitable partnership fostered co-learning and capacity building among all partners.
The opportunity to collaborate as partners on a community-based initiative resulted in benefits for all partners. The graduate internship program was implemented effectively because of each partner's contribution and dedication to the success of the program. It is hoped that the lessons learned from this program can assist others with the development of similar partnerships that benefit underserved communities.
Community coalitions are increasingly recognized as important strategies for addressing health disparities. By providing the opportunity to pool resources, they provide a means to develop and sustain innovative approaches to affect community health.
This article describes the challenges and lessons learned in building the Asian American Hepatitis B Program (AAHBP) coalition to conduct a community-based participatory research (CBPR) initiative to address hepatitis B (HBV) among New York City Asian-American communities.
Using the stages of coalition development as a framework, a comprehensive assessment of the process of developing and implementing the AAHBP coalition is presented.
Findings highlight the importance of developing a sound infrastructure and set of processes to foster a greater sense of ownership, shared vision, and investment in the program.
Grassroots community organizing and campus-community partnerships can be successfully leveraged to address and prevent a significant health disparity in an underserved and diverse community.
This paper describes a multilevel youth violence prevention effort called SAFER Latinos (Seguridad, Apoyo, Familia, Educacion, y Recursos), a collaboration between The George Washington University School of Public Health and Health Services (GWU) and two key Latino community organizations.
To implement and evaluate an intervention addressing factors within the social ecology of an immigrant Latino community.
The intervention includes (1) Social promotores for family outreach and problem resolution; (2) Youth peer advocates at the high school level; (3) a drop-in center with support services for families and youth; and (4) community events, capacity building, and messages. Evaluation includes a baseline and follow-up surveys (N = 1,400) and focus groups.
(1) Community circumstances change, requiring regular program adaptation. (2) Community interventions with research face potential contradictions in purpose impacting management of the collaboration and model fidelity. (3) Etiological models tied to interventions may have to be revisited owing to changes in the character and dynamics of the immigrant community.
With growing interest in the CBPR approach to cancer health disparities research, mechanisms are needed to support adherence to its principles. The Carolina Community Network (CCN), 1 of 25 Community Network Programs funded by the National Cancer Institute (NCI), developed a model for providing funds to community-based organizations.
This paper presents the rationale and structure of a Community Grants Program (CGP) model, describes the steps taken to implement the program, and discusses the lessons learned and recommendations for using the grants model for CBPR.
Three types of projects-cancer education, implementation of an evidence-based intervention, and the development of community-academic research partnerships-could be supported by a community grant. The CGP consists of four phases: Pre-award, peer-review process, post-award, and project implementation.
The CGP serves as a catalyst for developing and maintaining community-academic partnerships through its incorporation of CBPR principles.
Providing small grants to community-based organizations can identify organizations to serve as community research partners, fostering the CBPR approach in the development of community-academic partnerships by sharing resources and building capacity.
Practicing pediatricians are challenged to look beyond the clinical settings for local resources to address health threats to children and families. Pediatric residents' perceptions of the realities faced by families that they frequently see in the emergency room and outpatient or inpatient units are inadequate.
The Community Pediatrics Training Initiative (CPTI) is a national initiative within the American Academy of Pediatrics designed to prepare future pediatricians to serve families from traditionally underserved communities. The three unique components of this CPTI at Children's Hospital of Wisconsin (CHW) and the Medical College of Wisconsin (MCW) support child health improvement through (1) interactive discussions with families, (2) exposure to programs in community agencies, and (3) community initiatives.
Pediatric residents, along with community partners, have implemented more than 25 community initiatives in the areas of access to care, adolescent health, child advocacy, and environmental and public health.
The immediate assessment from our CPTI curriculum demonstrates community experiences significantly promote their competencies in child advocacy and system-based practice while expanding their knowledge of the impact of poverty. In 2005, a survey of 84 postgraduates (75% response rate) assessed the effectiveness of community pediatrics training. All graduates self-reported that they are moderately to greatly prepared to respond to children's culture, age, gender, and disabilities. Of the 43 (68%) graduates who are currently in practice, 10 (23%) are working directly with underserved populations.
The development of community initiatives by pediatric residents in partnership with community stakeholders greatly expanded residents' competencies in child health improvement.