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ICR Abstracts: 5.3
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Helena
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Mar 06, 2007 10:30 PST
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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 (5.3: March 6, 2007)
1. Adams, M. L. (2007). The African American breast cancer outreach
project: Partnering with communities. _Family & Community Health_, 30(1
Suppl), S85-94.
This article describes the African American Breast Cancer Screening
Outreach project, a community-based participatory intervention that was
designed to increase the numbers of African American women screened for
breast cancer in Texas, especially those who are poor and underserved.
The project was very successful, and between 1998 and 2003, more than
114,000 people received cancer information and education and 8,459
African American women who had contact with the project were screened.
Several lessons were learned from these experiences that are pertinent
to engaging communities to partner with researchers in conducting
community-based participatory research and illustrate the application of
guiding principles outlined by Israel and colleagues in 1998.
2. Aronson, R. E., A. B. Wallis, et al. (2007). Ethnographically
informed community evaluation: a framework and approach for evaluating
community-based initiatives. _Maternal and Child Health Journal_, 11(2),
97-109.
Objectives: This paper describes ethnographically informed community
evaluation (EICE), a framework for evaluating complex community-based
interventions, and illustrates its use in the evaluation of Baltimore
City Healthy Start, a federally funded infant mortality prevention
project. EICE, which is influenced by cultural anthropology and
assets-based community assessment, supports continuous program
improvement, resident involvement, and measurement of community-level
change. This approach takes into account both individual and contextual
levels of analysis. Methods: The evaluation coupled a participatory
approach with qualitative and survey research methods to study community
context and how it might contribute to infant mortality and influence
program implementation, and to assess community change resulting from
the program. Data collection included focus groups, key informant
interviews, surveys, neighborhood mapping, journaling, and a study of
community problem-solving. Results: The evaluation provided
program-related feedback to staff, contributed to a collective
understanding of the local context, validated and augmented outcome
findings, and imparted skills and a sense of empowerment to the
neighborhood. Results reveal a community burdened by crime and social
problems, yet showing great diversity in physical and social conditions
when examined at the census block group level. Nevertheless, these
social and physical hazards in the community are more salient than any
specific health issue such as infant mortality. Conclusions: EICE is a
powerful evaluation approach able to respond to the complexities of
community-based maternal and child health initiatives designed to
institute changes across multiple domains. EICE may be used, in whole or
in part, as a supplement to traditional designs.
3. Ataöv, A. and J. Haider. (2006). From Participation to Empowerment:
Critical Reflections on a Participatory Action Research Project with
Street Children in Turkey. _Children, Youth and Environments_ 16(2),
127-152.
This paper is based on a three-year participatory action research (PAR)
project conducted with children living and working on the streets of six
Turkish metropolitan cities. We first examine how the dominant policy
fails to acknowledge street children as actors in public space and
review empowering methodology for working with street children. Second,
we discuss the PAR methodology and how it facilitates meaningful
participation by street children. Third, we consider how the project
contributed to the inclusion of street children in public space.
Finally, we review the role of PAR in empowering street children.
4. Bradley, H. A. and T. Puoane. (2007). Prevention of hypertension and
diabetes in an urban setting in South Africa: participatory action
research with community health workers. _Ethnicity & Disease_, 17(1),
49-54.
The project aimed to identify factors that contribute to hypertension
and diabetes and to design and implement appropriate local interventions
to prevent these noncommunicable diseases and promote healthy
lifestyles. This was a community-based participatory action research
project in which researchers and community health workers (CHWs) were
the main participants. The triple A approach to planning interventions
was used, that is, the process of assessing the situation, analyzing the
findings, and taking action based on this analysis. Both qualitative and
quantitative methods were employed. Twenty-two CHWs working in site C,
Khayelitsha, a deprived urban area of Cape Town, South Africa,
participated in the study. Findings from the situational assessment
indicated a lack of knowledge among CHWs and the community about
hypertension and diabetes and the risk factors for these
non-communicable diseases. Economic constraints and cultural beliefs and
practices influenced the community's food choices and participation in
physical activity. On the basis of these findings, a training program
was proposed that would provide CHWs with the skills to prevent
hypertension and diabetes in their community. A program was developed
and piloted by the project team. A health club that focuses on promoting
healthy lifestyles is currently being piloted. This paper illustrates
the unique involvement of CHWs in a successful participatory action
research project on the prevention of hypertension and diabetes and
promotion of health in a deprived urban setting. The project emphasizes
the importance of involving local people in community-based initiatives
to promote health and identifies that the primary role of health
services is to develop appropriate skills in the local community,
monitor activities, and facilitate a link with primary health services.
5. Calman, N., K. Kitson, et al. (2006). Using Information Technology to
Improve Health Quality and Safety in Community Health Centers. _Progress
in Community Health Partnerships: Research, Education, and Action_,
1(1), 33-38.
Problem: Community health centers (CHCs) face a unique set of challenges
and can learn much from each other as they prepare for the adoption of
health information technology (HIT). Purpose: This paper presents a
research agenda aimed at providing information CHCs will need to
successfully implement HIT. Key Points: Community health centers must be
able to evaluate whether an investment in HIT is the best way to achieve
improvements in health outcomes for their communities given the limited
resources and high demands they face. Community health centers need
better information to guide them in selecting and implementing
information technology that will result in improved health quality and
safety. Guidance in optimal use of the system, particularly in the
effective use of data made available through electronic health records,
is needed to realize health care goals. Community health centers need to
be active participants in HIT developments in their communities to
ensure that their patients benefit from technological advancements that
improve health care.
6. Cornish, F. and R. Ghosh. (2007). The necessary contradictions of
'community-led' health promotion: A case study of HIV prevention in an
Indian red light district. _Social Science & Medicine_ 64(2), 496-507.
Health promotion interventions with marginalised groups are increasingly
expected to demonstrate genuine community participation in their design
and delivery. However, ideals of egalitarian democratic participation
are far removed from the starting point of the hierarchical and
exploitative social relations that typically characterise marginalised
communities. What scope is there for health promotion projects to
implement ideals of community leadership within the realities of
marginalisation and inequality? We examine how the Sonagachi Project, a
successful sex-worker-led HIV prevention project in India, has engaged
with the unequal social relations in which it is embedded. Our
ethnographic study is based on observation of the Project's
participatory activities and 39 interviews with a range of its
stakeholders (including sex worker employees of the Project,
non-sex-worker development professionals, brothel managers, sex workers'
clients). The analysis shows that the project is deeply shaped by its
relationships with non-sex-worker interest groups. In order to be
permitted access to the red light district, it has had to accommodate
the interests of local men's clubs and brothel managers. The economic
and organisational capacity to run such a project has depended upon the
direct input of development professionals and funding agencies. Thus,
the 'community' that leads this project is much wider than a local
grouping of marginalised sex workers. We argue that, given existing
power relations, the engagement with other interest groups was necessary
to the project's success. Moreover, as the project has developed, sex
workers' interests and leadership have gained increasing prominence. We
suggest that existing optimistic expectations of participation inhibit
acknowledgement of the troubling work of balancing power relations.
Rather than denying such power relations, projects should be expected to
plan for them.
7. Farquhar, S. A. and S. Wing (2003). "Methodological and ethical
considerations in community-driven environmental justice research: Two
case studies from rural North Carolina". _Community Based Participatory
Research for Health_. M. Minkler and N. Wallerstein. San Francisco,
Josey-Bass: 221-241.
(from the chapter) Explores issues regarding community based
participatory research (CBPR) through an examination of two public
health projects initiated by residents of rural eastern North Carolina.
Both projects provide examples of the collective efforts of
community-academic partnerships that were organized to challenge
environmental, social, and health disparities. The case studies involved
different community members and researchers and used varying research
methods, yet they faced similar obstacles and methodological dilemmas.
Both depended on a history of effective community organizing and the
existence of powerful community assets. This chapter concludes with a
discussion of the similarities and differences of the projects,
highlighting some of the universal challenges that many CBPR projects
must address. (PsycINFO Database Record (c) 2005 APA, all rights
reserved).
8. Foster, J. and K. Stanek. (2007). Cross-cultural considerations in
the conduct of community-based participatory research. _Family &
Community Health_, 30(1), 42-49.
This article explores cross-cultural challenges that arise when
university and community members collaborate in community-based
participatory research. As part of a project for primary prevention of
human immunodeficiency virus (HIV) infection, researchers trained
community leaders to jointly develop a research question and conduct a
pilot qualitative study in a Puerto Rican community in Massachusetts.
Different priorities of the community and university members about HIV
as a research topic underscored the need to continuously reflect on
developing a research question in community-based participatory
research. Recognizing the cultural assumptions of both university and
community members is an important component of capacity building among
collaborative research teams.
9. Fuller, C. M., S. Galea, et al. (2007). Multilevel community-based
intervention to increase access to sterile syringes among injection drug
users through pharmacy sales in New York City. _American Journal of
Public Health_, 97(1), 117-24.
OBJECTIVES: Research has indicated that there is minimal use of
pharmacies among injection drug users (IDUs) in specific neighborhoods
and among Black and Hispanic IDUs. We developed a community-based
participatory research partnership to determine whether a multilevel
intervention would increase sterile syringe access through a new policy
allowing nonprescription syringe sales in pharmacies. METHODS: We
targeted Harlem, NY (using the South Bronx for comparison), and
disseminated informational material at community forums, pharmacist
training programs, and counseling or outreach programs for IDUs. We
compared cross-sectional samples in 3 target populations (pre- and
postintervention): community members (attitudes and opinions),
pharmacists (opinions and practices), and IDUs (risk behaviors).
RESULTS: Among community members (N = 1496) and pharmacists (N = 131),
negative opinions of IDU syringe sales decreased in Harlem whereas there
was either no change or an increase in negative opinions in the
comparison community. Although pharmacy use by IDUs (N=728) increased in
both communities, pharmacy use increased significantly among Black IDUs
in Harlem, but not in the comparison community; syringe reuse
significantly decreased in Harlem, but not in the comparison community.
CONCLUSIONS: Targeting the individual and the social environment through
a multilevel community-based intervention reduced high-risk behavior,
particularly among Black IDUs.
10. Gates, D., B. Brehm, et al. (2006). Changing the work environment to
promote wellness: A focus group study. _AAOHN Journal: official journal
of the American Association of Occupational Health Nurses_, 54(12),
515-20.
It is estimated that employers spend more than 75 billion dollars
annually on obesity-attributable health care. Interventions to reduce or
prevent the risk of obesity are increasingly common at worksites and
include health fairs, weight loss and nutrition classes, and fitness
programs. However, many companies lack the resources to plan and
implement these types of programs. Environmental approaches offer
companies a low-cost option. A community-based participatory research
model was used to bring academic researchers, human resources personnel,
and health department educators together to plan and implement an
environmental program aimed at increasing healthy eating and physical
activity at four small manufacturing companies. The Diffusion of
Innovations Theory guided the development of focus group questions. A
focus group study was then conducted to gather information from
employees and managers at these four companies. The questions identified
workplace strategies that would aid in reducing barriers and developing
appropriate communication channels to enhance employee participation in
the program. The researchers identified themes from manager and employee
focus groups regarding the following five environmental components:
signs, walking paths, food changes, educational strategies, and advisory
groups.
11. Gona, J. K., S. Hartley, et al. (2006). Using participatory rural
appraisal (PRA) in the identification of children with disabilities in
rural Kilifi, Kenya. _Rural Remote Health_, 6(3), 553.
INTRODUCTION: Cross-sectional surveys have been used widely for
identifying children with disabilities, but they have several
disadvantages. The surveys concentrate on identifying impairments and do
not encourage the participation and ownership of the community.
Participatory rural appraisal (PRA) provides a cost-effective and
efficient method that reflects the local perceptions of disability and
involves local people. These factors are important for sustainability in
resource-poor countries. Purpose: To evaluate the application of PRA to
identifying children with disabilities in a rural setting. METHODS: PRA
was used to identify children with disabilities in two rural
sub-locations in Kilifi, Kenya. Data were collected through 12 focus
group discussions and 12 social mapping activities. A purposive
convenience sample of teachers, village leaders and women groups
participated in the PRA. The perceptions of disability were established
before identification of the children. The categories of identification
were based on these local perceptions. The qualitative data were
analyzed thematically and validation was performed through
triangulation. RESULTS: Disability was perceived locally as the
existence of impairments, activity limitations and participation
restrictions. Disabilities were associated with traditional beliefs
including witchcraft, evil spirits and punishments from God. In some
cases these categories were mutually exclusive and in others they were
concurrent. Children who had lost their parents and were not being cared
for by relatives (disadvantaged orphans) were also perceived as disabled
children by teachers and local women, but not by community leaders.
CONCLUSION: The results suggest that PRA is an efficient and
cost-effective method of identifying children with disabilities
according to local perceptions, and it may be useful in community-based
rehabilitation as an alternative to surveys.
12. Leonhardt, K. K., B. Deborah, et al. (2006). Partners in safety:
Implementing a community-based patient safety advisory council. _WMJ:
Official publication of the State Medical Society of Wisconsin_, 105(8),
54-9.
CONTEXT: A recommended strategy for improving patient safety is
patient-centered care, with the patient and provider functioning as
partners to achieve health care goals. OBJECTIVE: To implement a
community-based advisory council where patients and providers can
collaboratively develop interventions for safe medication use in the
outpatient setting. DESIGN, SETTING, PARTICIPANTS: A descriptive study
of the process used to implement a patient-provider advisory council in
Walworth County, Wisconsin in 2005-2006. Participants included patients
and health care professionals from Aurora Health Care and the community.
Using formative research and community-based participatory programs, the
Council developed medication safety interventions. MAIN OUTCOME
MEASURE(S): Establishment of a community-based patient-provider council;
development of interventions to improve medication safety in the
outpatient setting. RESULTS: The Walworth County Patient Safety Council
was established in November 2005, with 11 patient and 12 provider
representatives. The Council identified and developed multiple
interventions for patients and health care providers. CONCLUSIONS: A
community-based advisory council is an effective partnership model where
patients, providers, and their community can collaboratively develop
strategies for improving medication safety. As interventions are
disseminated in Walworth County, their effectiveness on medication
safety outcomes will be evaluated.
13. Maclean, L. M., E. Diem, et al. (2007). Complexity and team dynamics
in multiple intervention programmes: challenges and insights for public
health psychology. _Journal of Health Psychology_, 12(2), 341-51.
Psychologists engaged in public health research and intervention will
become more involved in multiple intervention programming approaches.
Managing innovation and complexity is a challenge when the team members
come from different disciplines, organizational cultures and research
perspectives. This report captures some of those challenges with a
participatory, capacity-building, community-based intervention over
research stages. We detail successful and less successful attempts to
manage the challenges within changing public health contexts and end
with concrete suggestions for teams with mixed intervention and research
goals. Insights from this project should inform similar programmes with
multi-level, participatory, community-based approaches.
14. Nguyen, T. T., S. J. McPhee, et al. (2006). Papanicolaou testing
among Vietnamese Americans: results of a multifaceted intervention.
_American Journal of Preventive Medicine_, 31(1), 1-9.
BACKGROUND: Vietnamese-American women have the highest incidence of
cervical cancer of any ethnic group, and they underutilize Papanicolaou
(Pap) tests. DESIGN: Development and implementation of a multifaceted
intervention using community-based participatory research (CBPR)
methodology and evaluated with a quasi-experimental controlled design
with cross-sectional pre-intervention (2000) and post-intervention
(2004) telephone surveys. Data were analyzed in 2005. SETTING: Santa
Clara County, California (intervention community) and Harris County,
Texas (comparison community). PARTICIPANTS: Vietnamese-American women
aged 18 and older (n =1566 at pre-intervention and 2009 at
post-intervention). INTERVENTION: A community-academic coalition
developed and implemented six components: Vietnamese-language media
campaign, lay health worker outreach, Vietnamese Pap clinic, patient
registry/reminder system, restoration of a government-funded low-cost
screening program, and continuing medical education for Vietnamese
physicians. OUTCOME MEASURE: Pap test receipt. RESULTS: Overall response
rate was 56%. Pap test receipt increased in the intervention (77.5% to
84.2%, p <0.001), but not in the comparison community (73.9% to 70.6%, p
| | 0.05). In multivariate analyses, the intervention was associated with
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increased Pap test receipt (odds ratio [OR]=2.02, 95% confidence
interval [CI]=1.37-2.99). Other factors associated with increased Pap
testing included longer U.S. residence, having health insurance, having
a regular site of care, having a respectful physician, having a
non-Vietnamese or a female Vietnamese physician, and recalling exposure
to Vietnamese-language media about Pap testing. Factors associated with
reduced likelihood of Pap test receipt were age 65 years and older,
never married, less than high school education, and income below poverty
level. CONCLUSIONS: A multifaceted CBPR intervention was associated with
increased Pap test receipt among Vietnamese-American women in one
community.
15. Rhodes, S. D., E. Eng, et al. (2007). Exploring Latino Men's HIV
Risk Using Community-based Participatory Research. _American Journal of
Health Behavior_, 31(2), 146-158.
Objectives: To explore sociocultural determinants of HIV risk and
identify potential intervention approaches among adult Latino men.
Methods: Using community-based participatory research for study design
and implementation and data analysis, 7 focus groups were conducted with
members of a soccer league in central North Carolina. Results: Five
themes emerged, including perceived barriers to accessing health care,
the role of hegemonic masculinity in risk, and potentially effective
intervention approaches to health promotion and disease prevention.
Conclusions: Latino soccer leagues may provide an effective social
network with which to partner to design, implement, and evaluate
interventions to reduce sexual risk among Latino men, who have been
inaccessible in conventional HIV/ STD prevention programs.
16. Senathirajah, Y., R. Kukafka, et al. (2006). Health Information
Seeking and Technology Use in Harlem: A Pilot Study using
Community-Based Participatory Research. _American Medical Informatics
Association Annual Symposium Proceedings_, 704-8.
AbstractHarlem is a well-known community with rich historical and
cultural significance but also serious longstanding health and economic
disparities. This qualitative focus group study used CBPR methods to
examine the attitudes, perceptions and opinions of English-speaking
adult and adolescent Harlem internet users, regarding health problems,
health information seeking, and technology access and use in Harlem. The
study aims to inform the development of technology interventions to
improve the health of Harlem residents. Analysis revealed that
participants experienced barriers in obtaining convenient and affordable
technology access but also demonstrated self-efficacy and sophistication
in using these resources to search for health information. While
healthcare providers were a preferred source of health information and
treatment, other sources used included acquaintances, libraries,
alternative medicine and home remedies, the internet, and school-based
programs. Respondents were aware of the effects of diet and environment
on health and aware and critical of structures which made it difficult
to improve these. The implications for technology development include
the need to increase access or use devices already owned by a majority
of residents, facilitate community organizing around issues which impact
health, and deliver any technological interventions with appropriately
convincing communication and usable interfaces which allow progressive
learning about both technology and health.
17. Singleton, J. L. (2006). Infusing gerontology throughout the BSW
curriculum. _Journal of Gerontological Social Work_, 48(1-2), 31-46.
How can social work educators ensure that all of their BSW students have
the savvy and "know-how" to deal with the needs of our growing aging
population? The development of broad-based, innovative gerontological
learning opportunities in a BSW program in a small liberal arts and
sciences college is presented in this article. Strategies for actively
involving community representatives in curriculum changes and
participatory learning experiences with students are shared.Ways to
incorporate various disciplines in the BSW education are explored in
addition to developing intergenerational projects, direct involvement of
older persons in the educational process, and ways to unite field
practice with theory.
18. Sutton, S. E. and S. P. Kemp. (2006). Integrating social science and
design inquiry through interdisciplinary design charrettes: An approach
to participatory community problem solving. _American Journal of
Community Psychology_, 38(1-2), 125-39.
Interdisciplinary collaborations that aim to facilitate meaningful
community outcomes require both the right mix of disciplinary knowledge
and effective community participation, which together can deepen
collective knowledge and the capacity to take action. This article
explores three interdisciplinary design charrettes, intensive
participatory workshops that addressed specific community problems and
provided a context for integrating design and social science inquiry
with local community knowledge. Evaluation data from the charrettes shed
light on how students from the design and social science disciplines
experienced the charrettes, and on their interactions with community
members. Key advantages to this interdisciplinary, community-based
collaboration included expanded knowledge derived from the use of
multiple modes of inquiry, particularly the resulting visualization
tools that helped community members understand local issues and envision
novel solutions. Key drawbacks included difficulties in balancing the
two disciplines, the tendency for social scientists to feel out of place
on designers' turf, and the increased disciplinary and interpersonal
conflicts arising from a more diverse pool of participants.
19. Tandon, S. D., K. Phillips, et al. (2006). A Vision for Progress in
Community Health Partnerships. _Progress in Community Health
Partnerships: Research, Education, and Action_, 1(1), 3-18.
Community-based participatory research (CBPR) is an increasingly used
approach for conducting research to improve community health. Using
Rogers’ diffusion of innovations theory as a framework, it follows that
future adoption of CBPR will occur if academic and community partners
perceive CBPR to have greater relative advantage, compatibility,
trialability, and observability, and less complexity than other research
approaches. We propose that articles published in our new peer-reviewed
journal— Progress in Community Health Partnerships: Research, Education,
and Action (PCHP)—can influence academic and community partners’
perceptions of CBPR that promote its adoption. Eight areas of scholarly
activity are described that can promote health partnership research,
education, and action: (1) original research, (2) work-inprogress and
lessons learned, (3) policy and practice, (4) theory and methods, (5)
education and training, (6) practical tools, (7) systematic reviews, and
(8) community perspectives. These eight areas correspond with the eight
main sections of PCHP. A brief description of each area’s importance in
promoting CBPR is provided along with examples of completed and ongoing
work. Specific recommendations are made regarding issues, problems, and
topics within each area on which CBPR work should focus. These
recommendations, which present a vision for progress in community health
partnerships, are based on idea generation and prioritization by a group
of CBPR experts—PCHP’s editors and editorial board.
20. Zoellner, J., C. Connell, et al. (2006). Fit for Life Steps: Results
of a Community Walking Intervention in the Rural Mississippi Delta.
_Progress in Community Health Partnerships: Research, Education, and
Action_, 1(1), 21-32.
Background: A collaborative community–university–U.S. Department of
Agriculture(USDA)/Agricultural Research Service (ARS) partnership
developed and implemented a 6-month walking intervention whereby
volunteer coaches were trained to lead community walking groups in a
rural Mississippi Delta communities. Objective: Assess the feasibility
of implementing community- based participatory research (CBPR), increase
physical activity, and improve anthropometric and biological measures.
Methods: This quasi-experimental design examined body mass index,
percent body fat, waist circumference, blood pressure, blood glucose,
lipid profile, self-reported walking, stages of change, social support,
self-efficacy, and decisional balance at enrollment, 3 months, and 6
months. Participants were primarily African American (99%) women (97%).
Changes were evaluated using repeated measures analysis of variance
(ANOVA) and Friedman’s test. Results: Community members actively
participated in assessing the problem, identifying the intervention,
interoriginal vention planning, data collection, and evaluation. Of
enrolled participants, 66 (80%) completed the intervention. Participants
exhibited significant improvements waist circumference (–1.4 inches),
systolic blood (–4.3 mmHg), and high-density lipoprotein (HDL)
cholesterol (+7.9 mg/dL; P < .001). Self-reported walking was 44.8
(SD+52.2) minutes at enrollment, 76.6 (SD+ minutes at 3-months, and 65.9
(SD+89.7) minutes months (P = .154). A positive stage of change shift
occurred in 57% of participants; however, no significant changes
occurred in the other psychosocial variables. Conclusion: The process of
developing and implementing this CBPR walking intervention was
considered successful as evidenced by the community’s active
contribution participation in each phase of this research, the
undertaking and application of basic research components, significant
improvements in several anthropometric and biological values, and
sustainability of the collaborative partnership.
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