Community-based Participatory Research Methods Research Articles

Creating Community-Academic Partnerships for Cancer Disparities Research and Health Promotion

To effectively attenuate cancer disparities in multiethnic, medically underserved populations, interventions must be developed collaboratively through solid community-academic partnerships and driven by community-based participatory research (CBPR). The Tampa Bay Community Cancer Network (TBCCN) has been created to identify and implement interventions to address local cancer disparities in partnership with community-based nonprofit organizations, faith-based groups, community health centers, local media, and adult literacy and education organizations. TBCCN activities and research efforts are geared toward addressing critical information and access issues related to cancer control and prevention in diverse communities in the Tampa Bay area. Such efforts include cross-cultural health promotion, screening, and awareness activities in addition to applied research projects that are rooted in communities and guided by CBPR methods. This article describes these activities as examples of partnership building to positively affect cancer disparities, promote community health, and set the stage for community-based research partnerships.

Photovoice: A Review of the Literature in Health and Public Health

Although a growing number of projects have been implemented using the community-based participatory research method known as photovoice, no known systematic review of the literature on this approach has been conducted to date. This review draws on the peer-reviewed literature on photovoice in public health and related disciplines conducted before January 2008 to determine (a) what defines the photovoice process, (b) the outcomes associated with photovoice, and (c) how the level of community participation is related to photovoice processes and outcomes. In all, 37 unduplicated articles were identified and reviewed using a descriptive coding scheme and Viswanathan et al.'s quality of participation tool. Findings reveal no relationship between group size and quality of participation but a direct relationship between the latter and project duration as well as with getting to action. More participatory projects also were associated with long-standing relationships between the community and outside researcher partners and an intensive training component. Although vague descriptions of project evaluation practices and a lack of consistent reporting precluded hard conclusions, 60% of projects reported an action component. Particularly among highly participatory projects, photovoice appears to contribute to an enhanced understanding of community assets and needs and to empowerment.

Using Community‐Based Participatory Research (CBPR) to Target Health Disparities in Families

Community-based participatory research (CBPR) is an action research approach that emphasizes collaborative partnerships between community members, community organizations, health care providers, and researchers to generate knowledge and solve local problems. Although relatively new to the field of family social science, family and health researchers have been using CBPR for over a decade. This paper will introduce CBPR methods, illustrate the usefulness of CBPR methods in families and health research, describe two CBPR projects related to diabetes, and conclude with lessons learned and strengths and weaknesses of CBPR.

Community Health Worker Insights on Their Training and Certification

Community Health Worker Insights on Their Training and Certification Caricia E. C. Catalani, Sally E. Findley, Sergio Matos, and Romelia Rodriguez What Is the Purpose of This Review? • To develop a consensus definition of community health workers (CHW) informed by practitioners of the field. • To document CHW training needs, both in content and training methods. • To identify CHW concerns for potential impact of the growing regulation on certification and reimbursement. • To engage CHW leadership and input to inform the study. What Is the Problem? • Uncertainty among employers, funders, stakeholders, and CHWs themselves regarding the definition of a CHW. • Confusion about CHW training needs, both in content and training methods. • Lack of research is hampering the development of training, certification, and reimbursement strategies and policies. What Are the Findings? • CHWs in New York have developed a consensus definition with uniformity of opinion on core elements of the definition. • Community trust is central to CHW identity, essential to the conduct of the practice, and inviolate. • We identified CHW training needs in the area of core competencies often neglected by health care systems, employers, or academia. • We identified characteristics of a credentialing process that would be acceptable to CHW practitioners and help advance and support the field. • Community-based participatory research (CBPR) methods provided unique insights into the definition, training needs, and credentialing concerns of CHWs. Who Should Care Most? • CHWs. • CHW employers, including community- and faith-based organizations, government agencies, hospitals, community health centers, and other health care providers. • CHW program funders, including state, local, and national governments, foundations, and philanthropies. • Primary care providers. • Chronic disease management programs. • Public health professionals and other allied health workers. [End Page 201] Recommendation for Action • CBPR is uniquely adaptable for research to address the growing interest in CHWs and their practice. • CBPR provides a mechanism for CHWs to inform policy makers and regulators about their credentialing desires and concerns and the potential impact of the growing certification and regulation movement across the country. • The CHW definition generated through the CBPR methods applied in this study is a potentially acceptable standard. • CPBR provided a view into a potentially acceptable process for developing a CHW credential. CHWs in New York City are generally supportive of credentialing, but only for a process that involves them and their leaders in its development. • This study has identified various content and methods training parameters that could lead to acceptable statewide credentialing standards for CHWs. CHWs in New York City have articulated specific training needs in two categories, including core competencies and health-specific topics. a Core competencies include skills training in communication, documentation, behavior change, adult learning, informal counseling, goal setting, negotiation/mediation, conflict resolution, and community organizing. b Training in health-specific topics includes chronic disease management, prevention and control, health care systems, insurance eligibility and enrollment, and immigration issues in health. • CHWs recognize the individual and organizational maturity required of institutions to adapt to their specific training needs, both in content and methods, and are eager to advance a supportive relationship. • CHWs identified themselves as nontraditional adult learners and therefore demand that educational institutions interested in providing training develop adult learning, participatory and interactive teaching skills to better serve the practice. CHWs further mentioned that evaluation of their competence should involve performance evaluation as opposed to standard test taking. • CHWs are uniquely qualified to help address some of the persistent disparities in health and health care access for isolated populations traditionally hard to reach with more conventional strategies. • CHWs must be involved in any certification, credentialing or training design from the very beginning. The integration of CHWs at all levels in program planning, implementation, and evaluation will provide the strongest foundation for creating a truly responsive educational program that builds on the CHWs’ knowledge of the communities where they live and work. Every opportunity in program development and implementation must be taken to ensure the voice of CHWs are included and respected. • This study exposes the need for further inquiry into the feasibility of CHW-centered and CHW-led credentialing. [End Page 202] Caricia E. C. Catalani Columbia University, Mailman School of Public Health Sally E. Findley Columbia University, Mailman School of Public Health Sergio Matos Columbia University, Mailman...

Using Ethnographic Methods to Articulate Community-Based Conceptions of Cultural Heritage Management

How can ethnographic methods help communities articulate and enact their own conceptions of heritage management? This and related questions are being explored through an international research project, 'Intellectual Property Issues in Cultural Heritage'. The project includes up to twenty community-based initiatives that incorporate community-based participatory research and ethnographic methods to explore emerging intellectual property-related issues in archaeological contexts; the means by which they are being addressed or resolved; and the broader implications of these issues and concerns. We discuss three examples that use ethnography to (a) articulate local or customary laws and principles of archaeological heritage management among a First Nations group in British Columbia; (b) assemble knowledge related to land/sea use and cultural practices of the Moriori people of Rekohu (Chatham Islands) for their use in future land and heritage management policies; and (c) aid a tribal cultural centre in Michigan in crafting co-management strategies to protect spiritual traditions associated with a rock art site on state property. Such situations call for participatory methods that place control over the design, process, products, and interpretation of 'archaeology' in the hands of cultural descendants. We hope that these examples of community-based conceptions of archaeological heritage management, facilitated through ethnographic methods and participatory approaches, will increase awareness of the value of these and other alternative approaches and the need to share them widely.

Implementing Community‐Based Participatory Research with Two Ethnic Minority Communities in Kansas City, Missouri

Community‐based participatory research (CBPR) has been shown to improve aspects of health promotion initiatives. This case study examines the effects of a CBPR intervention on intermediate outcomes (changes in the community) related to preventing health disparities and chronic disease. We describe how the Kansas City‐Chronic Disease Coalition used CBPR methods to help bring about community changes to reduce risk for cardiovascular diseases and diabetes among African Americans and Hispanics in Kansas City, Missouri. Using an empirical case study design, communities and scientific partners documented and analyzed the contribution of community changes (new or modified programs, policies or practices) facilitated by the coalition in two racial/ethnic communities: African American and Hispanic. Follow‐up interviews suggest that the coalition did a better job of implementing a CBPR intervention in the African American community than in the Hispanic community. Challenges to implementing CBPR interventions in multiple and diverse ethnic communities are discussed.

Applying community-based participatory research methods to improve maternal and child health in Karachi, Pakistan

To achieve health for all, the development of partnerships between community residents and researchers is essential. Community-based participatory research (CBPR) engages community members, uses local knowledge in the understanding of health problems and the design of interventions, and invests community members in the processes and products of research. CBPR pivots on an iterative process of open communication, mutual respect, and power sharing to build community capacity to sustain effective health interventions. This article describes how the tenets of CBPR were applied by a multidisciplinary, international research team of maternal-child health specialists toward better health for women and children in multilingual, multiethnic, low socioeconomic communities in Karachi, Pakistan.

Community-Based Participatory Research in Little Haiti: Challenges and Lessons Learned

Community-based participatory research (CBPR) is an effective methodology for developing relevant interventions with socially marginalized communities. However, implementing CBPR methods is challenging for several reasons. This paper presents challenges encountered in the context of an ongoing CBPR initiative in Little Haiti in Miami, Florida, and describes the solutions used to address them. We sought to describe the challenges faced and lessons learned while conducting CBPR in Little Haiti. Community-academic partnerships were created to guide the creation of culturally relevant cancer interventions and research. Historical distrust of research, cultural constructions of health and illness, and literacy issues are key considerations when developing partnerships with Haitian and other marginalized, immigrant communities. Partnerships are fostered over time through demonstrated mutual commitment to improving health and building community capacity. Communities must play an active role throughout the research process to ensure that studies are culturally relevant, and ensuing intervention, sustainable.

Patnè en Aksyon: Addressing Cancer Disparities in Little Haiti Through Research and Social Action

Haitian women living in Miami, Florida, experience an increased risk of developing and dying from cervical cancer compared with women in other racial/ethnic minority and immigrant groups in the area. In response to this disparity, academic investigators from a local university-based cancer center and community leaders from Little Haiti, the predominately Haitian neighborhood in Miami, created Patnè en Aksyon (Partners in Action), a campus-community partnership. We describe the partnership's effort to document the prevalence of lifetime and routine Papanicolau test use using community-based participatory research methods. Community health workers indigenous to the area recruited participants from various community venues throughout Little Haiti and administered informal, brief interviews to assess their screening practices. The results indicate that Haitian women are underscreened and underscore the importance of community involvement in study implementation.

African American Health Initiative Planning Project: A Social Ecological Approach Utilizing Community-Based Participatory Research Methods

Much of the scientific literature in the area of health continues to ask the question, “How can we get African Americans involved in research and prevention activities?” The African American Health Initiative represents an answer to this question and is in many ways a success story of a local Black population that willingly engaged in health planning through a community-based participatory research process. A mixed-method sequential exploratory design was utilized to implement the health planning process. A social ecological model was created with five levels of influence and was utilized as a guide for engagement. A total of 1,078 individuals (95% Black) participated. A comprehensive plan was created with nine recommendations for the improvement of the health of the local and neighboring Black populations.

Community Outreach for Stroke Education

See related article, pages 2331–2335. Educating the public on the warning signs of stroke is considered a critical part of the chain of survival and of better stroke care.1 Repeated studies have demonstrated that high-risk groups, such as the elderly, minority groups, or those of low socioeconomic status, often have the poorest knowledge of stroke warning signs.2–4 Although mass media can be a powerful tool in stroke public education,5 it is not without its limitations. To be effective, mass media needs adequate reach and frequency to break through the advertising “clutter”—which requires significant and sustained funding. Moreover, the ability of mass media to target specific high-risk subgroups, whether ethnic, socioeconomic, or linguistic, is unclear. In this issue of Stroke , Kleindorfer et al6 describe a community-based project in which beauticians were used to deliver stroke education to black women, …

Community/Campus Partnership: Tailoring Geographic Information Systems for Perinatal Health Planning

Geographic information systems (GIS) are seen as potentially important additions to traditional methods of studying risk factors in maternal and child health, but little is written on actual GIS use by communities. This article describes how one community-university collaboration used GIS for perinatal planning. The objective was to determine whether utilizing GIS could help a community to identify risk and develop potential interventions to address perinatal health problems. We tested the use of GIS over a 9-month period, using community-based participatory research (CBPR) methods. Diffusion of innovations (DOI) theory guided this work. This collaboration resulted in the development of a perinatal GIS model that helped community members to decide where to focus interventions and in continued use of GIS for planning. Close collaboration early in the planning process, coupled with the incorporation of DOI theory, is necessary for communities to use GIS to plan perinatal interventions.

Modifying Photovoice for community-based participatory Indigenous research

Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n=45) evaluated participants' perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, built capacity, and responded to cultural preferences. The authors discuss the necessity of modifying Photovoice, by building in an iterative process, as being key to the methodological success of the project.

Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR)

BackgroundCardiovascular disease remains the leading killer of women in most developed areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) methods.MethodsA total of 335 healthy, 25–64 years old women who had been selected by a multiple-stage stratified cluster random sampling method in Bushehr Port/I.R. Iran, were randomized into control and intervention groups. The intervention group completed an 8-week lifestyle modification program for increasing their physical activity, based on a revised form of Choose to Move program; an American Heart Association Physical Activity Program for Women. Audio-taped activity instructions with music and practical usage of the educational package were given to the intervention group in weekly home-visits by 53 volunteers from local non-governmental and community-based organizations.ResultsAmong the participants, the percentage who reported being active (at lease 30 minutes of moderate intensity physical activity for at least 5 days a week, or at least 20 minutes of vigorous physical activity for at least three days a week) increased from 3% and 2.7% at baseline to 13.4% and 3% (p < 0.0001) at the ending of the program in the intervention and control groups, respectively. The participants in the intervention group reported more minutes of physical activity per week (mean = 139.81, SE = 23.35) than women in the control group (mean = 40.14, SE = 12.65) at week 8 (p < 0.0001). The intervention group subjects exhibited a significantly greater decrease in systolic blood pressure (-10.0 mmHg) than the control group women (+2.0. mmHg). The mean ranks for posttest healthy heart knowledge in the intervention and control groups were 198.91 and 135.77, respectively (P < 0.0001).ConclusionAn intervention based on CBPR methods can be effective for the short-term adoption of physical activity behavior among women. The development of participatory process to support the adequate delivery of lifestyle-modification programs is feasible and an effective healthcare delivery strategy for cardiovascular community health promotion.Trial RegistrationACTRNO12606000521527

Patterns of tobacco use in a sample of American Indians in Minneapolis-St. Paul

The purpose of this study was to identify patterns of tobacco initiation, current use, and smoking cessation and their correlates in the adult American Indian population in the Twin Cities, using community-based participatory research methods. A total of 300 American Indians aged 18 years or older participated in in-person interviews. Participants were recruited to fill age-gender quotas that reflect the demographic distribution of American Indians in Minnesota. Almost everyone in this sample had smoked cigarettes recreationally: Only 12% had smoked fewer than 100 cigarettes, and nearly two-thirds (62%) reported that they were current smokers. Only 29% of ever-smokers had quit smoking. More than two-thirds (68%) of current smokers would like to quit, and most of them (53% of all smokers) had tried unsuccessfully to quit in the previous 12 months. Our results show a level of current smoking and low cessation rates among American Indians in the Twin Cities area that reflect a crisis for public health and for the Indian community.

Improving depression care for ethnic and racial minorities: A concept for an intervention that integrates CME planning with improvement strategies

Depression is one of the most common reasons that individuals seek treatment in the primary care setting. Research in the past 15 years has shown that dramatic improvement in the management of patients with depression is possible. Advances in pharmacotherapy and delivery of depression care have been reported, but few currently benefit members of ethnic and racial minorities. Educating physicians and other health professionals has been suggested as one approach to address the issues related to disparities in depression care. There is little evidence, however, that education alone is effective. The authors of this article believe that incorporating physician learning activities that are planned using approaches that have been shown to be effective in interventions currently demonstrating some success in improving depression care provided to ethnic and racial minorities will enhance the impact and sustainability of these interventions. This article--the conclusion of this supplement--will describe an intervention concept that integrates a quality improvement model (the Institute for Health Improvement's Breakthrough Series Collaborative model) with an evidence-based approach to planning CME and supports the integration by using action inquiry technologies and community-based participatory research methods. Relevant approaches from implementation research are discussed, and suggestions for testing the intervention concept are provided.

Using Mixed Methods to Examine Parental Influence on Youth Alcohol Use

This study identified youth and adult perceptions of factors that influence initiation of youth drinking, access to alcohol, strategies for deterring youth drinking, and parents' role in prevention. A combination of qualitative (focus group and individual interview) and quantitative (written survey) community-based participatory research methods was used. Results showed that parents and other adults influence youth decisions about alcohol use both positively and negatively. Parental strategies identified by both youths and adults as important for the prevention of youth alcohol use includes communication, modeling positive behavior, monitoring youths, and controlling youths' access to alcohol. Communication was considered the most effective strategy, especially if parents do not lecture or nag their children. Both parents and students viewed monitoring as important but in need of improvement. Most youths and adults believed it is easy for minors to obtain alcohol, usually from their own or friends' parents. However, few parents had talked with other parents about youth drinking. Youths' perceptions of alcohol use norms were assimilated from adults, but many parents reported difficulty in modeling positive drinking behavior. Parent education and support are needed to encourage parents to confront the extent of youth drinking and to improve their own prevention skills.

Risk Perception and Communication Regarding Pesticide Use in Rural Work: A Case Study in Rio de Janeiro State, Brazil

In an agricultural region of Rio de Janeiro State, Brazil, rapid assessment procedures were used for risk-perception studies based on methodologic triangulation that included semi-structured interviews, participatory observations, and focus groups. Data were qualitatively categorized. Women's risk perception was prioritized, as they did not recognize some risks they were exposed to during work activities. To reach women likely to be exposed to pesticides, a photographic soap opera (fotonovela) was constructed in collaboration with rural workers, using community-based participatory research methods. Contents of the risk-communication strategies included the harmful effects of pesticides. Results showed that the inclusion of risk-perception studies in the development of educative and risk-communication campaigns is very important, bridging research to action.

Conquering Cancer Disparities: New Opportunities for Cancer Epidemiology, Biomarker, and Prevention Research

Cancer disparities represent a significant public health problem in the United States. Inequity in cancer screening, incidence, treatment, prognosis, and mortality is a hallmark of many common cancers ([1][1]). These disparities exist across groups defined by race, ethnicity, gender, age, and

Book Review: Methods in Community-Based Participatory Research for Health

Book Review: Methods in Community-Based Participatory Research for Health