Community-based Participatory Research Efforts Research Articles

The Role of Black Churches in Promoting Mental Health for Communities of Socioeconomically Disadvantaged Black Americans.

Churches in socioeconomically disadvantaged neighborhoods serve as safe havens in many Black communities. Churches provide faith and charitable services but often have limited resources to address the mental health needs of their communities. This article reports on a collaborative effort, driven by members of a Black church, to understand mental health needs, coping strategies, and resilience factors in a community of socioeconomically disadvantaged Black Americans. A community-based participatory research effort was established among a church, a community mental health organization, clinicians, and researchers to interview and survey individuals residing near the church. The sample consisted of 59 adults, most of whom were ages 46-65 years, men (N=34, 58%), and unemployed (N=46, 78%). Mean scores on the Patient Health Questionnaire-9 (9.2±7.7) and Generalized Anxiety Disorder-7 scale (9.4±6.7) were almost three times higher than those reported by studies of other Black populations in the United States. Five themes emerged: prolonged poverty and daily exposure to violence trigger emotional distress, mental health stigma affects help seeking, spirituality promotes mental relief and personal recovery, spirituality helps in coping with poverty and unsafe neighborhoods, and church-based programs are needed. Uptake of traditional mental health services was low, and reliance on faith and resource distribution by the church was high. Church-led interventions are needed to promote mental health at the individual and community levels. Mental health stigma, and negative attitudes toward mental health promotion in the community, may be addressed by integrating traditional mental health services in church-based recreational and leisure activities.

Using Community-Based Participatory Research to Design a Patient and Practitioner-Centered Group Prenatal Care Model.

In response to disproportionately high rates of infant mortality and preterm birth among women of color and women in poverty in Fresno County, California, community and academic partners coordinated a community-based participatory research (CBPR) project with local residents. Social isolation and stress, inaccessible prenatal care, and dissatisfaction with care experiences were identified as leading predictors of poor birth outcomes. The PRECEDE-PROCEED framework was used to lead the CBPR effort that resulted in the development of a model of group prenatal care, named Glow! Group Prenatal Care Program (Glow! Program). Group prenatal care (GPNC), which focuses on pregnancy health assessments, education, and peer support, has the potential to address the health and social priorities of women during pregnancy. As a result of the employed CBPR process and the extensive participation from stakeholders, this modified GPNC model responds to the unique needs of the at-risk community members, the agencies aiming to improve maternal-child health experiences and outcomes, and the prenatal care providers offering it to their patients. The methods from this study can be applied in the design and implementation of community-based health care interventions. Returning to community partners throughout the design, implementation, and evaluation phases underscored that health care interventions cannot be designed in silos, and require flexibility to respond to factors that promote improved maternal and infant outcomes, which affect the end goal for the intervention.

Complicity in sociology and community-based participatory research with Marshallese.

Complicity with colonialism can be reflected in a particular approach to research, whose interests it serves, and who has power or ownership over the research process. It can also be reflected in neglect, inaction or methodological erasure of groups historically subjected to domination by colonial empires. Social scientists have often failed to account for colonialism's role or the complicit role they have played. We provide a brief historical overview of colonialism in the Marshall Islands and the role social scientists-and their methodological and epistemological approaches-played in the US empire's expansion into the region. We discuss the tenets of Community Based Participatory Research (CBPR), setting the research agenda, co-direction of the research process, research team membership, collaboration challenges, and the action and outputs which have come from our team's health disparities research among the largest Marshallese population in the continental US. We argue CBPR is a promising but imperfect approach to guarding against complicity within medical sociology and situate our methodological approach within ongoing debates regarding objectivity and advocacy within sociology. We reflect on successes and shortcomings of our CBPR efforts to address health disparities among Marshallese, as well as how those successes and shortcomings overlap with questions of complicity.

Examining community mental health providers'delivery of structured weight loss intervention to youth with serious emotional disturbance: An application of the theory of planned behaviour.

Rates of overweight and obesity are disproportionately high among youth with serious emotional disturbance (SED). Little is known about community mental health providers' delivery of weight loss interventions to this vulnerable population. This study examined attitudinal predictors of their providers' intentions to deliver weight loss interventions to youth with SED using the theory of planned behaviour. This study used a cross-sectional, single-time-point design to examine the relationship of the theory of planned behaviour constructs with behavioural intention. Community mental health providers (n = 101) serving youth with SED in the United States completed online clinical practice and theory of planned behaviour surveys. We examined the relationship of direct attitude constructs (i.e., attitude towards the behaviour, social norms and perceived behavioural control), role beliefs and moral norms with behavioural intention. Analyses included a confirmatory factor analysis and two-step linear regression. The structure of the model and the reliability of the questionnaire were supported. Direct attitude constructs, role beliefs and moral norms predicted behavioural intention to deliver weight loss interventions. While there is debate about the usefulness of the theory of planned behaviour, our results showed that traditional and newer attitudinal constructs appear to influence provider intentions to deliver weight loss interventions to youth with SED. Findings suggest preliminary strategies to increase provider intentions. This study was designed and the results were interpreted as part of a larger, community-based participatory research effort that included input from youth, families, providers, administrators and researchers. Collaborative discussions with community mental health providers and administrators particularly contributed to the study question asked as well as interpretation of results.

Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach.

Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.

Collaborative Transdisciplinary Research in a Small Institution: Challenges and Opportunities.

Aim/PurposeIn this paper, we discuss how a Transdisciplinary (TD) and a Community Based Participatory Research (CBPR) initiative was conceptualized, developed, implemented, and sustained at a small academic institution with limited research infrastructure, emphasizing die role of capacity building.BackgroundMost examples of die implementation of TD research come from large-scale initiatives in research-intensive institutions or centers widi multiple resources to establish collaborations among experts from different disciplines. However less is known about die implementation of TD and CBPR initiatives in small academic settings.MethodologyThis paper includes a discussion of the challenges and lessons learned of this process in a teaching-intensive Hispanic Serving Institution (HSI), which included a research component as part of the institutional priorities when it transitioned to a 4-year college in 2001.ContributionWe hope diat our experience helps odier researchers in similar institutions to engage in diis type of research.FindingsIn this case, a collaborative TD and CBPR initiative was successfully implemented despite limited resources for capacity building and research infrastructure, as well as diversity among researchers and community members.Recommendation for ResearchersTo sustain institutional collaborative capacity in this type of institution, authors recommend continuous capacity building efforts and the development of modules and/or courses to provide formal TD training for junior faculty while encouraging researchers to interact and collaborate. In addition, the importance of the role of the community liaison is highlighted.Impact on SocietySuccessful TD and CBPR initiatives may have a positive impact on the reduction or elimination of health disparities which involve complex phenomena that requires a broad view from different perspectives.Future ResearchEven though capacity building can facilitate the implementation of TD and CBPR, many challenges arise as an inherent result of community engagement and the integration of different disciplines. Thus, the need of continuous reflection to acknowledge them becomes critical for advancing TD and CBPR efforts.

Leveraging community-based participatory research capacity to recruit Pacific Islanders into a genetics study.

Pacific Islanders face many health disparities, including higher rates of cardiovascular disease, cancer, obesity, and diabetes compared to other racial and ethnic groups. Specifically, the Marshallese population suffers disproportionately from type 2 diabetes, with rates 400% higher than the general US population. As part of an ongoing community-based participatory research (CBPR) partnership, 148 participants were recruited for a study examining genetic variants to better understand diabetes. Participants provided a saliva specimen in an Oragene® DNA self-collection kit. Each participant provided approximately 2mL volume of saliva and was asked qualitative questions about their experience. The study yielded a recruitment rate of 95.5%. Among the 148 persons who participated, 143 (96.6%) agreed to be contacted for future studies; 142 (95.9%) agreed to have their samples used for future IRB-approved studies; and 144 (97.3%) gave permission for the researchers to link information from this study to other studies in which they had participated. Qualitative responses showed that the majority of participants were willing to participate because of their desire to contribute to the health of their community and to understand the genetic influence related to diabetes. This study demonstrates willingness to participate in genetic research among Marshallese living in Arkansas. Willingness was likely enhanced because the feasibility study was part of a larger CBPR effort. This study is important to community stakeholders who have voiced a desire to collaboratively conduct genetic research related to diabetes, perinatal outcomes, and cancer.

Community-based participatory research through virtual communities

ABSTRACTOver the last quarter century many new cyberspace platforms have emerged that facilitate communication across time, geographical distance and now even language. Whereas brick-and-mortar communities are defined by geographically local characteristics, a virtual community is an online community of individuals who socialize and connect around a common interest or theme using the Internet. Community-based participatory research (CBPR) is a public health approach that requires equitable partnerships between community members and researchers. Virtual communities abound on the Internet today, yet their application to CBPR is rarely considered. We examine three case studies to explore the advantages and challenges of virtual communities for CBPR, as well as several of the online tools CBPR practitioners can use to facilitate virtual community participation. There is a potential utility of virtual communities in supporting CBPR efforts as they reduce the effects of geographical barriers, maximize the growth potential of the community, and provide portable and affordable channels for real-time communication. Some caveats indicated in our case studies are: technological challenges, difficulty in crediting members’ contributions and determining ownership of content, no face-to-face interaction may hinder relationship formation, cohesion, and trust resulting in lower engagement. The paper concludes with recommendations for the use of virtual communities in CBPR projects, such as in the coordination of statewide health care policy initiatives and in the dissemination of best public health practices.

The Waponahki Tribal Health Assessment: Successfully Using CBPR to Conduct a Comprehensive and Baseline Health Assessment of Waponahki Tribal Members.

Describe a community-based participatory research effort between Tribal Health Departments in Maine and the University of Nebraska Medical Center (UNMC), College of Public Health to conduct a modified behavioral risk factors surveillance system with five Tribal communities in Maine. The study incorporated a long-distance community-based participatory research approach where Tribal Health Directors selected domains for the survey, modified the questions as needed, and advertised/recruited for the survey. Tribal interviewers trained via UNMC College of Public Health webinars conducted the surveys via computer assisted personal interviews at Tribal health centers or other Tribal facilities. Tribal interviewers uploaded surveys from the sites into a UNMC firewall protected data base. 1,127 Tribal members completed the survey. The methodology of this study can be adapted to other communities who wish to work longdistance with academic institutions to conduct community-based participatory research.

Growing partners: building a community-academic partnership to address health disparities in rural North Carolina.

Community-based participatory research (CBPR) holds tremendous promise for addressing public health disparities. As such, there is a need for academic institutions to build lasting partnerships with community organizations. Herein we have described the process of establishing a relationship between a research university and a Black church in rural North Carolina. We then discuss Harvest of Hope, the church-based pilot garden project that emerged from that partnership. The partnership began with a third-party effort to connect research universities with Black churches to address health disparities. Building this academic-community partnership included collaborating to determine research questions and programming priorities. Other aspects of the partnership included applying for funding together and building consensus on study budget and aims. The academic partners were responsible for administrative details and the community partners led programming and were largely responsible for participant recruitment. The community and academic partners collaborated to design and implement Harvest of Hope, a church-based pilot garden project involving 44 youth and adults. Community and academic partners shared responsibility for study design, recruitment, programming, and reporting of results. The successful operation of the Harvest of Hope project gave rise to a larger National Institutes of Health (NIH)-funded study, Faith, Farming and the Future (F3) involving 4 churches and 60 youth. Both projects were CBPR efforts to improve healthy food access and reducing chronic disease. This partnership continues to expand as we develop additional CBPR projects targeting physical activity, healthy eating, and environmental justice, among others. Benefits of the partnership include increased community ownership and cultural appropriateness of interventions. Challenges include managing expectations of diverse parties and adequate communication. Lessons learned and strategies for building and maintaining similar partnerships are discussed. The benefits of community-based research for addressing health disparities are many, and there are lessons to be learned that can strengthen community-academic partnerships.

HUB City Steps: A 6-Month Lifestyle Intervention Improves Blood Pressure among a Primarily African-American Community

The effectiveness of community-based participatory research (CBPR) efforts to address the disproportionate burden of hypertension among African Americans remains largely untested. The objective of this 6-month, noncontrolled, pre-/post-experimental intervention was to examine the effectiveness of a CBPR intervention in achieving improvements in blood pressure, anthropometric measures, biological measures, and diet. Conducted in 2010, this multicomponent lifestyle intervention included motivational enhancement, social support provided by peer coaches, pedometer diary self-monitoring, and monthly nutrition and physical activity education sessions. Of 269 enrolled participants, 94% were African American and 85% were female. Statistical analysis included generalized linear mixed models using maximum likelihood estimation. From baseline to 6 months, blood pressure decreased significantly: mean (±standard deviation) systolic blood pressure decreased from 126.0±19.1 to 119.6±15.8 mm Hg, P=0.0002; mean diastolic blood pressure decreased from 83.2±12.3 to 78.6±11.1 mm Hg, P<0.0001). Sugar intake also decreased significantly as compared with baseline (by approximately 3 tsp; P<0.0001). Time differences were not apparent for any other measures. Results from this study suggest that CBPR efforts are a viable and effective strategy for implementing nonpharmacologic, multicomponent, lifestyle interventions that can help address the persistent racial and ethnic disparities in hypertension treatment and control. Outcome findings help fill gaps in the literature for effectively translating lifestyle interventions to reach and engage African-American communities to reduce the burden of hypertension.

The impact of implementing selected CBPR strategies to address disparities in urban Atlanta: a retrospective case study

In 2005, the Institute of Public Health at Georgia State University (GSU) received a 3-year community-based participatory research (CBPR) grant from the National Center for Minority Health and Health Disparities entitled Accountable Communities: Healthy Together (ACHT). Because urban health disparities result from complex interactions among social, economic and environmental factors, ACHT used specific CBPR strategies to engage residents, and promote the participation of community organizations serving, a low-income community in urban Atlanta to: (i) identify priority health and social or environmental problems and (ii) undertake actions to mitigate those problems. Three years after funding ended, a retrospective case study, using semi-structured, taped interviews was carried out to determine what impacts, if any, specific CBPR strategies had on: (i) eliciting resident input into the identification of priority problems and (ii) prompting actions by community organizations to address those problems. Results suggest that the CBPR strategies used were associated with changes that were supported and sustained after grant funding ended. Insights were also gained on the longer term impacts of ACHT on community health workers. Implications for future CBPR efforts, for researchers and for funders, are discussed.

Disentangling the Exposure Experience

This article examines participants' responses to receiving their results in a study of household exposure to endocrine disrupting compounds and other pollutants. The authors study how the "exposure experience"-the embodied, personal experience and understanding of chronic exposure to environmental pollutants-is shaped by community context and the report-back process itself. In addition, the authors investigate an activist, collective form of exposure experience. The authors analyze themes of expectations and learning, trust, and action. The findings reveal that while participants interpret scientific results to affirm lay knowledge of urban industrial toxics, they also absorb new information regarding other pollutant sources. By linking the public understanding of science literature to the illness and exposure experience concepts, this study unravels the complex relationship between lay experience and lay understanding of science. It also shows that to support policy development and/or social change, community-based participatory research efforts must attend to participants' understanding of science.

Community Violence Exposure and Positive Youth Development in Urban Youth

Youth in urban environments are exposed to community violence, yet some do well and continue on a positive developmental trajectory. This study investigated the relationships between lifetime community violence exposure (including total, hearing about, witnessing, and victimization), family functioning, and positive youth development (PYD) among 110 urban youth ages 10-16 years (54% female) using a paper and pen self-report survey. This cross-sectional study was part of an interdisciplinary community-based participatory research effort in West/Southwest Philadelphia. Almost 97% of the sample reported some type of community violence exposure. Controlling for presence of mother in the home and presence of father in the home, separate linear regression models for PYD by each type of community violence exposure indicated that gender and family functioning were significantly associated with PYD. None of the types of community violence exposure were significant in the models. Significant interactions between gender and presence of mother in the home and gender and family functioning helped better explain these relationships for some of the types of community violence exposure. Presence of mother was associated with higher PYD for girls, but not for boys. Boys with poor family functioning had lower PYD than girls with poor family functioning. This study helps to better delineate relationships between CVE and PYD by adding new knowledge to the literature on the role of family functioning. Points of intervention should focus on families, with attention to parental figures in the home and overall family functioning.

Global Goods Movement and the Local Burden of Childhood Asthma in Southern California

As part of a community-based participatory research effort, we estimated the preventable burden of childhood asthma associated with air pollution in the southern California communities of Long Beach and Riverside. We calculated attributable fractions for 2 air pollution reduction scenarios to include assessment of the newly recognized health effects associated with residential proximity to major roads and impact from ship emissions. Approximately 1600 (9%) of all childhood asthma cases in Long Beach and 690 (6%) in Riverside were attributed to traffic proximity. Ship emissions accounted for 1400 (21%) bronchitis episodes and, in more modest proportions, health care visits for asthma. Considerably greater reductions in asthma morbidity could be obtained by reducing nitrogen dioxide and ozone concentrations to levels found in clean coastal communities. Both Long Beach and Riverside have heavy automobile traffic corridors as well as truck traffic and regional pollution originating in the Los Angeles-Long Beach port complex, the largest in the United States. Community-based quantitative risk analyses can improve our understanding of health problems and help promote public health in transportation planning.

Development of a Community-Based Participatory Research Effort to Evaluate Conventional HIV Testing (CHT) and HIV Rapid Testing (HRT)

A community-based participatory research (CBPR) project was created to study the effects of changing HIV testing protocols on client risk behaviors in an urban area. Concerns raised by the agency advisory group led to development of research questions that needed to be addressed within the community. The article focuses on development of the research partnership and study enrollment during the first year of the project. Challenges of assimilating rapid advances in health technology while conducting outreach to high-risk clients are discussed. Successes and lessons learned are described, including adaptation of theory-based interventions to research protocol and multi-level community coordination.

Challenges and Facilitating Factors in Sustaining Community-Based Participatory Research Partnerships: Lessons Learned from the Detroit, New York City and Seattle Urban Research Centers

In order to address the social, physical and economic determinants of urban health, researchers, public health practitioners, and community members have turned to more comprehensive and participatory approaches to research and interventions. One such approach, community-based participatory research (CBPR) in public health, has received considerable attention over the past decade, and numerous publications have described theoretical underpinnings, values, principles and practice. Issues related to the long-term sustainability of partnerships and activities have received limited attention. The purpose of this article is to examine the experiences and lessons learned from three Urban Research Centers (URCs) in Detroit, New York City, and Seattle, which were initially established in 1995 with core support from the Centers for Disease Control and Prevention (CDC). The experience of these Centers after core funding ceased in 2003 provides a case study to identify the challenges and facilitating factors for sustaining partnerships. We examine three broad dimensions of CBPR partnerships that we consider important for sustainability: (1) sustaining relationships and commitments among the partners involved; (2) sustaining the knowledge, capacity and values generated from the partnership; and (3) sustaining funding, staff, programs, policy changes and the partnership itself. We discuss the challenges faced by the URCs in sustaining these dimensions and the strategies used to overcome these challenges. Based on these experiences, we offer recommendations for: strategies that partnerships may find useful in sustaining their CBPR efforts; ways in which a Center mechanism can be useful for promoting sustainability; and considerations for funders of CBPR to increase sustainability.

Local Struggles for Environmental Justice: Activating Knowledge for Change

ABSTRACT Environmental knowledge and how it is acquired and deployed are important features of local environmental politics in the US. This paper is an ethnography of a community-based participatory research effort for environmental justice in Phoenix, Arizona. Residents, professional community activists, and university-based researchers worked together to conduct a health and environmental concerns survey and monitor air quality in a low-income Latino neighborhood. Analysis of this case explores how neighborhood struggles for environmental justice can result in socioenvironmental change through the activation of knowledge in certain political-legal frames. The interpenetration of lay knowledge and expert knowledge during community-based participatory research is theorized to spur environmental justice action when enabled by political-legal structures, and subvert the supposed binary between science and advocacy. The role of the university in community-based participatory research is also examined. Catalysis through involvement, more so than research results, emerges as an important role for the university in influencing environmental justice action.

Community-Based Participatory Research with Workers and Unions: Issues and Challenges

Dr. June Fisher was an inspiration not only for the core principles of Community Based Participatory Research (CBPR), but also for the understanding of context, the political, social, and ethical context of how and where collaborative work takes place. This paper unpacks the values, assumptions, and dilemmas faced by health professionals interested in working in authentic partnerships with unions, associations of non-unionized workers, and management-worker teams. Issues of privilege, race, power, and participation are raised as topics to think about and negotiate honestly as our work unfolds in communities. Local CBPR efforts are placed in the context of globalization and we are asked to consider how to situate our struggles in the largest context, while not losing sight of our own personal and community contributions.