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ICR Abstracts: 4.8
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The Institute for Community Research
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Aug 14, 2006 13:12 PDT
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[Editor's note: The following articles have been selected because they
collectively deal with a variety of issues related to community-based
research (e.g., collaboration, ethics, methods) and they cover various
disciplines. If you have suggestions for articles/publications for
future postings, or other feedback in the
presentation, simply reply to this email. Thanks for joining!]
ICR Abstracts (4.8: August 14, 2006)
1. Brown, K., J. Dyas, et al. (2006). "Discovering the research
priorities of people with diabetes in a multicultural community: A focus
group study." _British Journal of General Practice_ 56(524): 206-13.
BACKGROUND: Usually experts decide on which research is worthwhile, yet
it is government policy to involve service users in research. There has
been a lack of published research about involving patients from minority
ethnic groups and people from deprived areas in setting research
agendas. In this study we wanted to hear the voices of patients that are
not often heard. AIM: To find out the research priorities of people with
diabetes from an inner city community and compare these with current
expert-led research priorities in diabetes. DESIGN OF STUDY: A
qualitative study using a participatory approach with consumer groups.
SETTING: Primary care within inner city Nottingham, UK. METHOD:
Thirty-nine adult patients with diabetes with varying ethnic backgrounds
recruited from three general practices. Six focus groups carried out in
participants' preferred language, analysed using the constant
comparative method. RESULTS: Nine main themes equating to research
priorities were identified. Within these themes, information and
awareness, service delivery and primary prevention of diabetes emerged
as the main factors. There were no science-based topics and there was
more emphasis on culturally influenced research questions, which
differed from recent Department of Health priorities. There were several
themes about service delivery, patient self-management and screening and
prevention of diabetes that overlapped. CONCLUSIONS: There is some
divergence between expert-led and patient-led agendas in research about
diabetes. Patient perspectives have a significant influence on research
priorities, and there are likely to be several different patient
perspectives.
2. Carlson, E. D., J. Engebretson, et al. (2006). "Photovoice as a
social process of critical consciousness." _Qualitative Health Research_
16(6): 836-52.
The reluctance of some communities to participate in research and
researchers' lack of penetration into the community are major stumbling
blocks to successful community-based approaches. The authors'purpose is
to determine how a photovoice project in a lower income, African
American, urban community was able to generate a social process that
resulted in active grassroots participation in a community-campus
partnership. Through this partnership initiative, the authors asked
neighborhood residents to take photographs of things in the community of
which they were proud and the things they wanted to change, and to tell
the story of why these were important. The authors used strategies from
visual anthropology to analyze the 54 photographs, stories, and dialogue
produced. Their analysis identified three distinct levels of
cognitive-emotional interpretations that moved participants out of
helplessness toward authentic engagement and participation. The authors
discuss implications and lessons learned for community-based
participatory research.
3. Chandra, A. and A. Batada (2006). "Exploring stress and coping among
urban African American adolescents: the Shifting the Lens study." _Prev
Chronic Dis_ 3(2): A40.
INTRODUCTION: Stress can have a significant effect on an adolescent's
long-term physical and mental well-being. An understanding of the role
of unmanaged stress during early adolescence is critical for the
prevention of chronic diseases such as depression. The purpose of the
Shifting the Lens study was to explore perceptions of stress, sources of
social support, and use of coping strategies among urban African
American ninth graders. METHODS: A youth-driven, mixed-method approach
was used to assess teens' perceptions of stress. During the 2001-2002
school year, teen participants (N = 26) from East Baltimore, Md,
completed questionnaires, audio journals, pile-sort activities, and
personal social support network maps. RESULTS: In contrast with existing
literature that emphasizes the influence of violence and neighborhood
factors on stress among teens, teens prioritized other sources of
stress, particularly from school, friends, and family. For support, they
relied on different individuals, depending on the source of the
stress--friends for romantic relationship stress and family for job,
school, and family stress. Sex differences in the coping styles of the
participating teens were found. Girls reported more frequent use of
support-seeking and active coping strategies than boys. CONCLUSION: The
use of multiple data collection strategies to explore stress uniquely
contributes to our understanding of how one group of teens perceives and
copes with stress. Future research should explore stress from the youth
perspective in communities that are similar to East Baltimore, Md. In
addition, programmatic recommendations include the need for sex-specific
stress management activities and education about youth stress for
adults. Community participatory translation interventions based on study
findings, such as a youth-produced video and a resource guide for youth
service providers, were implemented.
Available online: http://www.cdc.gov/pcd/issues/2006/apr/05_0174.htm.
4. Edwards, N. C. and S. M. Roelofs (2006). "Sustainability: the elusive
dimension of international health projects." _Canadian Journal of Public
Health_ 97(1): 45-9.
OBJECTIVE: The Canada-China Yunnan Maternal and Child Health Project
(1997-2003) sought to improve the quality of village life and promote
development of productivity and social prosperity in Yunnan province,
China. PARTICIPANTS: The project targeted grassroots maternal and child
health workers: new and in-service village doctors; traditional village
midwives; doctors at township health centres; doctors at county maternal
and child health hospitals; and provincial health staff. SETTING: Ten
impoverished counties (population 2.2 million) in Yunnan province with
high proportions of ethnic minority populations. INTERVENTION: There
were three major innovations: training grassroots maternal and child
health workers in participatory and community-based approaches and
clinical skills; designing a model comprehensive referral system
including provision of basic equipment; and introducing participatory
monitoring and evaluation methods. Strategies to support sustainability
were built into the project from the outset. OUTCOMES: Over 4,000
village, township, and county health workers received training.
Maternal, infant, and under-five mortality rates declined over 30% in
project counties. Project innovations were disseminated throughout the
province, into other donor-funded initiatives, and integrated into
national health projects by local partners. CONCLUSION: Maintaining the
long-term benefits of international health interventions depends on
sustaining innovations beyond short project timelines. Achieving
sustainability poses a conundrum to implementing agencies. Three
mechanisms influenced uptake in the Yunnan project: maintaining a good
fit between core project elements and the existing health system;
developing adequate organizational supports; and creating a handover
plan from the outset. This project highlights some of the ways in which
sustainability can be operationalized.
5. Esperat, M. C., D. Feng, et al. (2005). "Transformation for health: a
framework for health disparities research." _Nursing Outlook_ 53(3):
113-20.
The task of generating knowledge addressing disparities in health among
vulnerable populations in American society is explored. The
community-based participatory approach as an alternate paradigm to
traditional research is mentioned as a process for understanding the
realities of the populations of interest. Identification and testing of
mediating and moderating variables is suggested to guide the process of
increasing knowledge regarding health disparities. Transformation for
Health is proposed as a conceptual framework to study how these third
variables influence the relationship between the primary variables of
interest. A theoretical example is offered describing the application of
the framework to study the mediators and moderators in an investigation
of childhood obesity. Analytical challenges in the exploration of "third
variables" are described, and the authors recommend that salient
methodological issues should be addressed when conducting these types of
investigations.
6. Hueston, W. J., A. G. Mainous, 3rd, et al. (2006). "Protecting
participants in family medicine research: A consensus statement on
improving research integrity and participants' safety in educational
research, community-based participatory research, and practice network
research." _Family Medicine_ 38(2): 116-20.
Recent events that include the deaths of research subjects and the
falsification of data have drawn greater scrutiny on assuring research
data integrity and protecting participants. Several organizations have
created guidelines to help guide researchers working in the area of
clinical trials and ensure that their research is safe and valid.
However, family medicine researchers often engage in research that
differs from a typical clinical trial. Investigators working in the
areas of educational research, community-based participatory research,
and practice-based network research would benefit from similar
recommendations to guide their own research. With funding from the US
Office of Research Integrity and the Association of American Medical
Colleges, we convened a panel to review issues of data integrity and
participant protection in educational research, community-based
participatory research, and research conducted by practice-based
networks. The panel generated 11 recommendations for researchers working
in these areas. Three key recommendations include the need for (1) all
educational research to undergo review and approval by an institutional
review board (IRB), (2) community-based participatory research to be
approved not just by an IRB but also by appropriate community
representatives, and (3) practice-based researchers to undertake only
valid and meaningful studies that can be reviewed by a central IRB,
rather than separate IRBs for each participating practice.
Full text available online:
http://www.stfm.org/fmhub/fm2006/February/William116.pdf
7. Knightbridge, S. M., R. King, et al. (2006). "Using participatory
action research in a community-based initiative addressing complex
mental health needs." _Australian & New Zealand Journal of Psychiatry_
40(4): 325-32.
OBJECTIVE: This paper describes the first phase of a larger project that
utilizes participatory action research to examine complex mental health
needs across an extensive group of stakeholders in the community.
METHOD: Within an objective qualitative analysis of focus group
discussions the social ecological model is utilized to explore how
integrative activities can be informed, planned and implemented across
multiple elements and levels of a system. Seventy-one primary care
workers, managers, policy-makers, consumers and carers from across the
southern metropolitan and Gippsland regions of Victoria, Australia took
part in seven focus groups. All groups responded to an identical set of
focusing questions. RESULTS: Participants produced an explanatory model
describing the service system, as it relates to people with complex
needs, across the levels of social ecological analysis. Qualitative
themes analysis identified four priority areas to be addressed in order
to improve the system's capacity for working with complexity. These
included: (i) system fragmentation; (ii) integrative case management
practices; (iii) community attitudes; and (iv) money and resources.
CONCLUSIONS: The emergent themes provide clues as to how complexity is
constructed and interpreted across the system of involved agencies and
interest groups. The implications these findings have for the
development and evaluation of this community capacity-building project
were examined from the perspective of constructing interventions that
address both top-down and bottom-up processes.
8. Kristina, T. N., G. D. Majoor, et al. (2005). "Does CBE come close to
what it should be? A case study from the developing world. Evaluating a
programme in action against objectives on paper." _Education for Health:
Change in Learning & Practice_ 18(2): 194-208.
CONTEXT: A growing number of health professions schools have implemented
programmes for community-based education (CBE) for their students. There
are indications, however, that particularly in developing countries, CBE
programmes are not always optimally implemented or sustained. OBJECTIVE:
To test the suitability of an established method for curriculum
evaluation, combined with a set of generic objectives for CBE
programmes, for evaluation of CBE programmes. METHODS: As a case study,
Coles and Grant's model for curriculum evaluation was applied to the CBE
programme of the Medical Faculty of Diponegoro University (MFDU) in
Semarang, Indonesia. Document analysis yielded information on the
programme on paper; participatory observation and staff interviews on
the programme in action. In addition, MFDU's CBE programme was evaluated
against a set of generic objectives for CBE programmes recently designed
by us. RESULTS: MFDU has created great opportunities for its CBE
programme in which, however, also significant weaknesses were revealed.
(1) In the community, much time was spent on formal teaching; (2)
Students' work in the community was not jointly identified with
community members regarding the community's felt health needs; (3) There
was rarely continuity, and evaluation or follow-up of the students' work
in the community; and (4) No systematic programme evaluations are
carried out. DISCUSSION: This evaluation study showed shortcomings in
the implementation of MFDU's CBE programme. The major weaknesses
identified point at an underutilization of the opportunities and
potential jeopardization of the facilities in the community. On the
other hand, more time is needed in the CBE programme to establish the
health needs to be addressed jointly with the community and to assess
the impact of activities undertaken. A thorough review of the CBE
programme, perhaps taking the outcomes of this study into account, could
turn MFDU's CBE programme into a fine example for other medical schools
in Indonesia and beyond. CONCLUSION: Coles and Grant's method for
curriculum evaluation proved suitable for evaluation of a CBE programme
in a developing country. After additional comparison with a reference
list of objectives for CBE programmes, reasoned suggestions for
programme can be made.
9. Macaulay, A. C. and P. A. Nutting (2006). "Moving the frontiers
forward: Incorporating community-based participatory research into
practice-based research networks." _Annals of Family Medicine_ 4(1):
4-7.
10. Olney, C. A. (2005). "Using evaluation to adapt health information
outreach to the complex environments of community-based organizations."
_J Med Libr Assoc_ 93(4 Suppl): S57-67.
OBJECTIVE: After arguing that most community-based organizations (CBOs)
function as complex adaptive systems, this white paper describes the
evaluation goals, questions, indicators, and methods most important at
different stages of community-based health information outreach. MAIN
POINTS: This paper presents the basic characteristics of complex
adaptive systems and argues that the typical CBO can be considered this
type of system. It then presents evaluation as a tool for helping
outreach teams adapt their outreach efforts to the CBO environment and
thus maximize success. Finally, it describes the goals, questions,
indicators, and methods most important or helpful at each stage of
evaluation (community assessment, needs assessment and planning, process
evaluation, and outcomes assessment). LITERATURE: Literature from
complex adaptive systems as applied to health care, business, and
evaluation settings is presented. Evaluation models and applications,
particularly those based on participatory approaches, are presented as
methods for maximizing the effectiveness of evaluation in dynamic CBO
environments. CONCLUSION: If one accepts that CBOs function as complex
adaptive systems-characterized by dynamic relationships among many
agents, influences, and forces-then effective evaluation at the stages
of community assessment, needs assessment and planning, process
evaluation, and outcomes assessment is critical to outreach success.
Full text available online:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1255754
11. Polacsek, M., L. M. O'Brien, et al. (2006). "Move & Improve: A
worksite wellness program in Maine." _Preventing Chronic Disease_ 3(3):
A101.
BACKGROUND: We describe the evaluation process and outcomes of Move &
Improve, a worksite wellness program in Maine. The evaluation process
was based on the Centers for Disease Control and Prevention's Framework
for Program Evaluation in Public Health and community-based
participatory research principles. Innovative approaches are required to
address burgeoning chronic disease trends and risk factors. Worksites
are an ideal setting in which to affect working adults and high-risk
individuals. Using community-based participatory research methodology
increases community capacity for evaluation, dissemination, and use of
evaluation results. CONTEXT: Move & Improve is an ongoing program that
was implemented in 1996. Although evaluation data have been collected
since the program's inception, a more systematic evaluation based on
community-based participatory research principles was undertaken in 2003
and 2004 with the technical assistance of the Maine-Harvard Prevention
Research Center and Colby College. METHODS: The Maine-Harvard Prevention
Research Center facilitated the development of a program logic model,
evaluation questions, data collection instruments, an analysis plan,
presentations, and reports. We used a cross-sectional study design with
nonparticipant comparison groups. CONSEQUENCES: Data indicate possible
program improvement strategies and substantial improvements in lifestyle
factors among participants. INTERPRETATION: Limitations of the
evaluation include participant self-selection, cross-sectional study
design, a lack of adequate resources for evaluation, and the challenges
of using community-based participatory research methods. Despite these
limitations, Move & Improve program staff consider the evaluation of the
program a success and have learned ways to improve the program and
future evaluation efforts. Overall satisfaction with the process has
been nurtured through community-based participatory research methods.
This approach also enabled us to meet key evaluation standards.
12. Sadler, K. E., C. A. McGarrigle, et al. (2006). "Mayisha II: Pilot
of a community-based survey of sexual attitudes and lifestyles and
anonymous HIV testing within African communities in London." _AIDS Care_
18(4): 398-403.
The pilot aim was to assess the feasibility and acceptability of
undertaking anonymous HIV testing using oral fluid samples as part of a
community-based survey of sexual attitudes and lifestyles of black
African communities in London. The three components of the study were
administered in various venues across London: (1) a cross-sectional
self-completion anonymous questionnaire survey, (2) an optional oral
fluid sample for anonymous HIV testing and (3) a nested in-depth
interview study in a sub-set of respondents. A total of 114 black
African men and women were recruited. A large number of African
countries were represented among respondents from newly-migrant and
well-established communities. The response rate to the oral fluid sample
was high at 82% and all samples collected were of sufficient quality to
be tested for HIV. In-depth interviews with respondents revealed
positive views and experiences about participating in the study whilst
understanding of the questionnaire was good. We therefore conclude that
anonymous HIV testing as part of a community-based survey is feasible
and acceptable, whilst a set of recommendations was produced to refine
the survey methodology and questionnaire. Participatory research methods
are essential for achieving successful community-based surveys among
black Africans in Britain.
13. Salois, E. M., P. A. Holkup, et al. (2006). "Research as spiritual
covenant." _Western Journal of Nursing Research_ 28(5): 505-24.
Conducting research with Native American communities poses special
challenges from misunderstandings that may arise from the interface of
differing cultural worldviews held by the scientific and the Native
communities. Although the community-based participatory research
approach shows promise for conducting research that can maximize
benefits and minimize the risks of harm to Native American people, there
is little information related to the practical implementation of
culturally appropriate research practices when working with Native
American communities. Drawing on the authors' research with three Native
American communities in the Northwest, this article describes culturally
appropriate processes for engaging Native American communities. The
first section identifies and describes the principles that provide the
foundation for the authors' research activity as a spiritual covenant
and guides the authors' research with the three communities. The second
section describes the project phase matrix that was used to organize the
approaches employed in this work.
14. Schulz, A. J., C. C. Gravlee, et al. (2006). "Discrimination,
symptoms of depression, and self-rated health among African American
women in Detroit: Results from a longitudinal analysis." _American
Journal of Public Health_ 96(7): 1265-70.
OBJECTIVES: Our understanding of the relationships between perceived
discrimination and health was limited by the cross-sectional design of
most previous studies. We examined the longitudinal association of
self-reported everyday discrimination with depressive symptoms and
self-rated general health. METHODS: Data came from 2 waves (1996 and
2001) of the Eastside Village Health Worker Partnership survey, a
community-based participatory survey of African American women living on
Detroit's east side (n=343). We use longitudinal models to test the
hypothesis that a change in everyday discrimination over time is
associated with a change in self-reported symptoms of depression
(positive) and on self-reported general health status (negative).
RESULTS: We found that a change over time in discrimination was
significantly associated with a change over time in depressive symptoms
(positive) (b=0.125; P<.001) and self-rated general health (negative)
(b=-0.163; P<.05) independent of age, education, or income. CONCLUSIONS:
The results reported here are consistent with the hypothesis that
everyday encounters with discrimination are causally associated with
poor mental and physical health outcomes. In this sample of African
American women, this association holds above and beyond the effects of
income and education.
15. Sloane, D., L. Nascimento, et al. (2006). "Assessing resource
environments to target prevention interventions in community chronic
disease control." _Journal of Health Care for the Poor & Underserved_
17(2 Suppl): 146-58.
The recent emphasis in public health and medicine on the environmental
determinants of chronic illness has created the need for a more
comprehensive way to assess barriers and facilitators of healthy living.
This paper reports on the approach taken by a Centers for Disease
Control and Prevention (CDC)-funded project whose goal is to reduce
disparities in diabetes and cardiovascular disease in Los Angeles'
African American communities. Findings from this community-based
participatory research project suggest that while location is an
important variable in evaluating nutritional and physical activity
resources, quality and price considerations are at least as useful. We
argue that every community or neighborhood is located within a resource
environment for medical care, recreation, food, and other
health-promoting or health-compromising goods and services that affect
the lives and health of its residents.
16. Solomon, N. M. (2005). "Health information generation and
utilization for informed decision-making in equitable health service
management: the case of Kenya Partnership for Health program."
_International Journal for Equity in Health_ 4: 8.
CONTEXT: The Kenya Partnership for Health (KPH) program began in 1999,
and is currently one of the 12 field projects participating in the WHO's
'Towards Unity for Health initiative' implemented to develop partnership
synergies in support of the Primary Health Care (PHC) approach 1.
CONTENT: This paper illustrates how Program-linked Information
Management by Integrative-participatory Research Approach (PIMIRA) as
practised under KPH has been implemented within Trans-Nzoia District,
Kenya to enhance community-based health initiatives. It shows how this
model is strategically being scaled-up from one community to another in
the management of political, social, cultural and economic determinants
(barriers and enhancers) of health. OBJECTIVE: Target rural communities
in the development of a community-based health information management
and feedback initiatives that can provide insights on the social,
cultural, political and economic determinants of health for utilization
in informed health service management. KEY FINDINGS AND ACHIEVEMENTS: 1.
Cues for health seeking and health service utilization are determined by
the social, cultural, political and economic factors as seen by the
individual and as defined by the community but not due to the
pathological nature of the illness. 2. Establishment of community-based
health surveillance and health action initiatives as the best practices
in transferring health as a resource that can be 'owned and guarded' by
the community. 3. Establishment of Healthy Villages Initiative (HVI)
through which health service delivery and scale-up can be sustained at
the community level. 4. Provision of actionable health information
necessary for health planning and evaluation of preventive health
programs thorough PIMIRA. CONCLUSION: It has been realized that for
every one person who visits a health facility for medication, there are
nine others who had the same condition but sought health care from other
sources including self-medication and five others who never sought
health care. Innovative means of involving the community in health
information management and utilization such as PIMIRA are hence the best
ways of guaranteeing equitable delivery of health services that are
accessible and sustainable by the community.
Full text available online: http://www.equityhealthj.com/content/4/1/8
17. Taylor, J., C. Hughes, et al. (2005). "Unique issues in research and
evaluation in rural and remote locations: Is there a place for specific
research training?" _Rural & Remote Health_ 5(2): 351.
BACKGROUND: There is increased interest in building research capacity in
rural health research in Australia and internationally. In Australia,
the Primary Health Care Research Evaluation and Development program
funded by the Australian Government has supported this move. Overall
this program aims to build the quantum of primary healthcare research to
underpin clinical practice, health systems improvement, and policy. In
order to achieve this objective, one strand of the program aims to build
research capacity among practitioners. In implementing this program in
rural and remote areas of the west of South Australia, the Spencer Gulf
Rural Health School has identified methodological and research design
issues faced by practitioners who are researching in their communities.
These issues include problems encountered in living and researching in
the same location and accessing small-scale statistical information. We
were interested to know whether there was interest in a formal course
(Rural Research and Evaluation) that would address these issues and
provide information about community-based research designs. METHODS: A
cross-sectional anonymous survey was designed and sent to 141
organisations in the health, human service, and local government sectors
in regional South Australia. Respondents were asked to evaluate the
demand and interest for a new course--Rural Research and Evaluation. The
term 'rural' was used to refer to both rural and remote locations.
Information was sought on the respondent's role in the organisation,
current level of research participation, views about the proposed course
content, and factors that the respondent thought would facilitate or
inhibit their participation. The majority of questions were close-ended.
RESULTS: Sixty surveys were returned giving a 42.5% response rate. Data
were analysed using descriptive statistics. A high level of research and
evaluation activity was reported with 80% of respondents undertaking
research or evaluation as part of their professional role. There was
also agreement that all the proposed topics were important to be
included in a course. Each of the topics was ranked at four or five on a
five-point scale by at least 58% of respondents. The topic
'understanding evaluation methodologies' was ranked at four or five by
85% of respondents, making it the most highly ranked topic. There was
also consensus about the features respondents thought would make the
course attractive for them to study. Over half (62%) of the respondents
ranked having lecturers with a broad rural research background at five,
very important, on a five-point scale. Almost half (48%) of the
respondents ranked online delivery at five, a very important factor in
making the course attractive to study. CONCLUSIONS: Those interested in
research and evaluation may have been more likely to return the survey
and there may have been respondent bias in this regard. Therefore the
results must be interpreted with caution. However, the level of
agreement with the proposed course topics may suggest that these reflect
important issues in undertaking research and evaluation in rural and
remote locations. If this is the case there is value in discussion about
how these issues are dealt with in different contexts in order to
overcome some of the barriers to effective research.
18. Wallerstein, N. B. and B. Duran (2006). "Using Community-Based
Participatory Research to Address Health Disparities." _Health Promotion
Practice_ 7(3): 312-323.
Community-based participatory research (CBPR) has emerged in the past
decades as an alternative research paradigm, which integrates education
and social action to improve health and reduce health disparities. More
than a set of research methods, CBPR is an orientation to research that
focuses on relationships between academic and community partners, with
principles of colearning, mutual benefit, and long-term commitment and
incorporates community theories, participation, and practices into the
research efforts. As CBPR matures, tensions have become recognized that
challenge the mutuality of the research relationship, including issues
of power, privilege, participation, community consent, racial and/or
ethnic discrimination, and the role of research in social change. This
article focuses on these challenges as a dynamic and ever-changing
context of the researcher-community relationship, provides examples of
these paradoxes from work in tribal communities, discusses the evidence
that CBPR reduces disparities, and recommends transforming the culture
of academia to strengthen collaborative research relationships.
19. Wells, K. B., A. Staunton, et al. (2006). "Building an
academic-community partnered network for clinical services research: the
Community Health Improvement Collaborative (CHIC)." _Ethnicity &
Disease_ 16(1 Suppl 1): S3-17.
OBJECTIVE: Community-based participatory research is recommended for
research on health disparities and to improve uptake of clinical
research findings. We describe the development of a multicenter
consortium designed to support a community agency-academic partner
infrastructure to support community-based, health-services research on
multiple sources of health and healthcare disparities in local
communities. DESIGN: We describe the development of the Los Angeles
Community Health Improvement Collaborative (CHIC). RESULTS: The CHIC
partners examined the research capacity and health priorities of its
partners and developed a research agenda focused on four tracer
conditions (depression, violence, diabetes, and obesity) and four areas
for development of research capacity: public participation in all phases
of research; understanding community and organizational context for
clinical services interventions; practical clinical services trial
methods; and advancing health information technology for clinical
services research. The partners pooled resources to develop these areas
for the tracer conditions. CONCLUSIONS: The challenges of a
participatory approach to community-based clinical services research go
beyond the significant methodologic and operational issues for specific
projects and include building a sustainable capacity for research,
community programs, and partnership across diverse communities and
stakeholder organizations even when funding sources are not fully
aligned with these goals.
20. Wynn, T. A., R. E. Johnson, et al. (2006). "Addressing disparities
through coalition building: Alabama REACH 2010 lessons learned."
_Journal of Health Care for the Poor & Underserved_ 17(2 Suppl): 55-77.
Community-based coalitions have become accepted vehicles for addressing
complex health problems. Few articles have described the challenges and
lessons learned from such a process. The purpose of this paper is
two-fold: 1) to describe the processes involved in building and
maintaining the REACH 2010 Alabama Breast and Cervical Cancer Control
Coalition (ABCCCC) and 2) to highlight the lessons learned from this
venture. Principles from community-based participatory research were
used 1) to establish and maintain the ABCCCC, 2) to build coalition
capacity, and 3) to develop breast and cervical cancer interventions.
Over 95% of our coalition has been maintained over a 7-year period. The
ABCCCC received a total of 17 breast and cervical cancer mini-grants.
Adherence to ground rules such as exhibiting respect and trust and
practicing open communication helped to solidify our partnership.
Lessons learned from the ABCCCC can provide others with an in-depth
exploration of the processes involved in coalition formation and
maintenance.
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