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ICR Abstracts: 5.6
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Helena
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Jun 26, 2007 06:53 PDT
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The Institute for Community Research would like to thank all who
attended and contributed to our international conference, "Crossroads
II: Community-Based Collaborative Research for Social Justice." We hope
you enjoyed your time with us and have gained new insights and
opportunities to advance effective actions for social justice!
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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 (5.6: June 26, 2007)
1. Bailie, R. S., D. Si, et al. (2007). Indigenous health: Effective and
sustainable health services through continuous quality improvement. _The
Medical Journal of Australia_, 186(10), 525-7.
The Australian government's Healthy for Life program is supporting
capacity development in Indigenous primary care using continuous quality
improvement (CQI) techniques. An important influence on the Healthy for
Life program has been the ABCD research project. The key features
contributing to the success of the project are described. The ABCD
research project: uses a CQI approach, with an ongoing cycle of
gathering data on how well organisational systems are functioning, and
developing and then implementing improvements; is guided by widely
accepted principles of community-based research, which emphasise
participation; and adheres to the principles and values of Indigenous
health research and service delivery. The potential for improving health
outcomes in Aboriginal and Torres Strait Islander communities using a
CQI approach should be strengthened by clear clinical and managerial
leadership, supporting service organisations at the community level, and
applying participatory-action principles.
2. Bryant, T., D. Raphael, et al. (2007). Identifying and strengthening
the structural roots of urban health in Canada: participatory policy
research and the urban health agenda. _Promotion & Education_, 14(1),
6-11.
An urban health research agenda for health promoters is presented. In
Canada, urban issues are emerging as a major concern of policy makers.
The voices raising these issues are from the non-health sectors, but
many of these issues such as increasing income inequality and poverty,
homelessness and housing insecurity, and social exclusion of youth,
immigrants, and ethno-racial minorities have strong health implications
as they are important social determinants of health. Emphasis on these
and other social determinants of health and the policy decisions that
strengthen or weaken them is timely as the quality of Canadian urban
environments has become especially problematic. We argue for a
participatory urban health research and action agenda with four
components: (a) an emphasis on health promotion and the social
determinants of health; (b) community-based participatory research; and
(c) drawing on the lived experience of people to influence (d) policy
analysis and policy change. Urban health researchers and promoters are
urged to draw upon new developments in population health and
community-based health promotion theory and research to identify and
strengthen the roots of urban health through citizen action on public
policy.
3. Chung, P. J., R. Travis, Jr., et al. (2007). Acculturation and
parent-adolescent communication about sex in Filipino-American families:
a community-based participatory research study. _Journal of Adolescent
Health_, 40(6), 543-50.
PURPOSE: To examine whether acculturation is associated with
parent-adolescent communication about sex in Filipino-American families.
Filipino-Americans, the United States' second-largest Asian and Pacific
Islander (API) group, have more adolescent pregnancy and HIV infection
than other APIs. High-quality parent-adolescent communication about sex
has been associated with healthy sexual development, and acculturation
has been associated with various increased health risks. Whether
acculturation affects parent-adolescent communication is unknown.
METHODS: We surveyed 120 pairs of Filipino-American parents and
adolescents at a single large high school. We asked adolescents about
their frequency of parent-adolescent communication about sex and
measured adolescent acculturation in two ways: disagreement with
traditional Asian values and preferential use of English. In bivariate
and multivariate regressions, we examined whether adolescent
acculturation was associated with adolescent reports of
parent-adolescent communication. RESULTS: Few adolescents (22%) reported
regularly discussing sex with parents. Although most adolescents (72%)
agreed with traditional Asian values, most (63%) preferred using
English. In bivariate regressions, less parent-adolescent communication
about sex was associated with less adolescent agreement with traditional
Asian values (p = .002) and more adolescent English use (p = .009). In
multivariate regressions, these associations were largely explained by
adolescent perceptions of parent knowledge about their whereabouts and
activities. CONCLUSIONS: Acculturation may influence Filipino-American
parent-adolescent communication about sex and, consequently,
Filipino-American adolescent sexual health. Health care and public
health providers may need to tailor adolescent sexual health programs
based on acculturation or other immigration-related factors.
4. Corbett, A. M., K. Francis, et al. (2007). Feminist-informed
participatory action research: A methodology of choice for examining
critical nursing issues. _International Journal of Nursing Practice_,
13(2), 81-88.
Feminist-informed participatory action research: A methodology of choice
for examining critical nursing issues Identifying a methodology to guide
a study that aims to enhance service delivery can be challenging.
Participatory action research offers a solution to this challenge as it
both informs and is informed by critical social theory. In addition,
using a feminist lens helps acquiesce this approach as a suitable
methodology for changing practice. This methodology embraces empowerment
self-determination and the facilitation of agreed change as central
tenets that guide the research process. Encouraged by the work of
Foucault, Friere, Habermas, and Maguire, this paper explicates the
philosophical assumptions underpinning critical social theory and
outlines how feminist influences are complimentary in exploring the
processes and applications of nursing research that seeks to embrace
change.
5. Devine, A., M. Kermode, et al. (2007). A participatory intervention
to improve the mental health of widows of injecting drug users in
north-east India as a strategy for HIV prevention. _BMC International
Health and Human Rights_, 7(1-8), 3.
ABSTRACT: BACKGROUND: Manipur and Nagaland, in the north-east of India,
are classified as high prevalence states for HIV, and intravenous drug
use is an important route of transmission. Most injecting drug users
(IDUs) are men, an estimated 40% are married, and death rates have been
high in the last five years, consequently the number of widows of IDUs
has increased. Many of these widows and their children are HIV-infected
and experience poor health, discrimination, and impoverishment; all
factors likely to be compromising their mental health. People with poor
mental health are more likely to engage in HIV risk behaviours. Mental
health can be promoted by public health actions with vulnerable
population groups. METHODS: We designed an intervention study to assess
the feasibility and impact of a participatory action process to promote
the mental health and well-being of widows of IDUs in Manipur and
Nagaland, as a strategy for reducing the risk of engagement in HIV risk
behaviours. This paper describes the background and rationale for the
study, the intervention, and the study methods in detail. RESULTS:
Pending analysis. CONCLUSION: This intervention study will make a
significant contribution to the emerging evidence that supports
associations between mental health and HIV. The concept of promoting
mental health among women who are vulnerable to HIV infection or already
infected as a strategy for HIV prevention in a development setting is
breaking new ground.
Full text available online:
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1857694&blobtype=pdf
6. Economos, C. D., R. R. Hyatt, et al. (2007). A Community Intervention
Reduces BMI z-score in Children: Shape Up Somerville First Year Results.
_Obesity_, 15(5), 1325-1336.
Objective: The objective was to test the hypothesis that a
community-based environmental change intervention could prevent weight
gain in young children (7.6 {+/-} 1.0 years). Research Methods and
Procedures: A non-randomized controlled trial was conducted in three
culturally diverse urban cities in Massachusetts. Somerville was the
intervention community; two socio-demographically-matched cities were
control communities. Children (n = 1178) in grades 1 to 3 attending
public elementary schools participated in an intervention designed to
bring the energy equation into balance by increasing physical activity
options and availability of healthful foods within the before-, during-,
after-school, home, and community environments. Many groups and
individuals within the community (including children, parents, teachers,
school food service providers, city departments, policy makers,
healthcare providers, before- and after-school programs, restaurants,
and the media) were engaged in the intervention. The main outcome
measure was change in BMI z-score. Results: At baseline, 44% (n = 385),
36% (n = 561), and 43% (n = 232) of children were above the 85th
percentile for BMI z-score in the intervention and the two control
communities, respectively. In the intervention community, BMI z-score
decreased by -0.1005 (p = 0.001, 95% confidence interval, -0.1151 to
-0.0859) compared with children in the control communities after
controlling for baseline covariates. Discussion: A community-based
environmental change intervention decreased BMI z-score in children at
high risk for obesity. These results are significant given the
obesigenic environmental backdrop against which the intervention
occurred. This model demonstrates promise for communities throughout the
country confronted with escalating childhood obesity rates.
7. Faridi, Z., J. A. Grunbaum, et al. (2007). Community-based
Participatory Research: Necessary Next Steps. _Preventing Chronic
Disease_, 4(3), A70.
Community-based participatory research (CBPR) is gaining increasing
credence among public health researchers and practitioners. However,
there is no standardization in assessing the quality of research
methods, the effectiveness of the interventions, and the reporting
requirements in the literature. The absence of standardization precludes
meaningful comparisons of CBPR studies. Several authors have proposed a
broad set of competencies required for CBPR research for both
individuals and organizations, but the discussion remains fragmented.
The Prevention Research Centers (PRC) Program recently began a
qualitative assessment of its national efforts, including an evaluation
of how PRCs implement CBPR studies. Topics of interest include types of
community partnerships; community capacity for research, evaluation, and
training; and factors that help and hinder partner relationships. The
assessment will likely contribute to the development of a standard set
of competencies and resources required for effective CBPR.
8. Felix, H. C. (2007). The Rise of the Community-Based Participatory
Research Initiative at the National Institute for Environmental Health
Sciences: An Historical Analysis Using the Policy Streams Model.
_Progress in Community Health Partnerships: Research, Education, and
Action_, 1.1, 1-10.
Background: C ommunity-based participatory research (CBPR) is an
approach to research that seeks equitable and collaborative involvement
of community members and researchers in all aspects of the research
process. It has moved slowly into the areas of health and public health
research. In 1995, the National Institute for Environmental Health
Sciences (NIEHS) launched the first research initiative at NIH
specifying the use of the CBPR approach. Objectives: The purpose of
this paper is to provide the historical record and to identify factors
and events that led to the development of the policy creating the CBPR
initiative at NIEHS. Methods: The study used Kingdon’s policy streams
model as an analysis framework. The policy streams model explains that
policies are developed when three “streams” (problem, policy and
political) come together at a point called the policy window.
Information collected from key informant interviews and document
analyses were coded to the components of the policy streams model.
Results: The study documented factors and events in each of the three
streams of the model. All these occurred about the same time to bring
together the three streams, causing the opening of a policy window. This
analysis demonstrates an importance of problem awareness and changes in
leadership positions or ideology/mood to bring a policy option to the
attention of policymakers, and the importance of a policy entrepreneur
to advocate for a particular policy when the opportunity arises.
Conclusions: Policy entrepreneurs should be alert for opportunities to
take advantage of the open policy windows
when they emerge, thereby achieving success in moving policy ideas
forward.
Full text available online:
http://muse.jhu.edu/demo/progress_in_community_health_partnerships_research_education_and_action/v001/1.1felix.pdf
9. Flaskerud, J. H. (2007). Cultutal Competence: What is it? _Issues in
Mental Health Nursing_, 28(1), 121-123.
10. Garland, A., D. Plemmons, et al. (2006). Research–Practice
Partnership in Mental Health: Lessons from Participants. _Administration
and Policy in Mental Health and Mental Health Services Research_, 33(5),
517-528.
Despite pervasive calls for increased collaboration between researchers
and practitioners, there has been limited research on research–practice
partnership in mental health. This qualitative study describes one
research–practice partnership that supports a study of community-based
psychotherapy for children and families. Semi-structured interviews were
conducted with all 12 participants (six Researchers and six
Practitioners) to elicit perceptions of the collaborative process,
including (a) attitudes and experiences entering into the collaboration,
(b) perceived challenges and benefits, and (c) suggestions for
improvements in future efforts. The findings reinforce the central role
of communication and trust-building in developing effective
collaborations and exchanging knowledge.
11. Hills, M., J. Mullett, et al. (2007). Community-based participatory
action research: Transforming multidisciplinary practice in primary
health care. _Revista Panamericana de Salud Publica_, 21(2-3), 125-35.
OBJECTIVES: Health care systems throughout the world are in the process
of restructuring and reforming their health service delivery systems,
reorienting themselves to a primary health care (PHC) model that uses
multidisciplinary practice (MDP) teams to provide a range of
coordinated, integrated services. This study explores the challenges of
putting the MDP approach into practice in one community in a city in
Canada. METHODS: The data we analyzed were derived from a
community-based participatory action research (CBPAR) project, conducted
in 2004, that was used to enhance collaborative MDP in a PHC center
serving a residential and small-business community of 11,000 within a
medium-sized city of approximately 300,000 people in Canada. CBPAR is a
planned, systematic approach to issues relevant to the community of
interest, requires community involvement, has a problem-solving focus,
is directed at societal change, and makes a lasting contribution to the
community. We drew from one aspect of this complex, multiyear project
aimed at transforming the rhetoric advocating PHC reform into actual
sustainable practices. The community studied was diverse with respect to
age, socioeconomics, and lifestyle. Its interdisciplinary team serves
approximately 3,000 patients annually, 30% of whom are 65 years or
older. This PHC center's multidisciplinary, integrated approach to care
makes it a member of a very distinct minority within the larger primary
care system in Canada. RESULTS: Analysis of practice in PHC revealed
entrenched and unconscious ideas of the limitations and boundaries of
practice. In the rhetoric of PHC, MDP was lauded by many. In practice,
however, collaborative, multidisciplinary team approaches to care were
difficult to achieve. CONCLUSIONS: The successful implementation of an
MDP approach to PHC requires moving away from physician-driven care.
This can only be achieved once there is a change in the underlying
structures, values, power relations, and roles defined by the health
care system and the community at large, where physicians are
traditionally ranked above other care providers. The CBPAR methodology
allows community members and the health-related professionals who serve
them to take ownership of the research and to critically reflect on
iterative cycles of evaluation. This provides an opportunity for
practitioners to implement relevant changes based on internally
generated analyses.
12. Kelley, M. A., W. Baldyga, et al. (2005). Capturing change in a
Community-University Partnership: Si Se Puede! Project. _Preventing
Chronic Disease_, 2(2), A22.
BACKGROUND: Community health interventions are increasingly employing
partnerships combined with multilevel intervention models to achieve
their objectives. Resources and methods for project evaluation are often
limited to changes in population health status or health behaviors,
while broader contextual questions that may illuminate mechanisms for
change across ecological levels and project sustainability may not be
addressed. CONTEXT: This paper describes a project to prevent and
control diabetes in a Latino community and presents practical methods
for addressing some challenges to evaluation, using data sources that
often may be overlooked. METHODS: A case study method was used to
examine approaches to capture data that can help explain changes across
ecological levels. An ecological framework was used to organize sources
of data. Data sources and findings are related to project timelines and
goals. CONSEQUENCES: Although not a direct focus of the original
research, substantial changes in community capacity were observed and
measured over the course of the five-year project. Documentation on
community change was found in routine project reports, logs, the news
media, meeting minutes, and community documents. INTERPRETATION: A
logical progression of community change across ecological levels became
evident. A modest post hoc evaluation was feasible, using data routinely
available from project and target community sources. Specific questions
for future research on how community change occurs and how such changes
may relate to population health and sustainability are suggested.
13. Menzies, C. R. (2004). Putting Words into Action: Negotiating
Collaborative Research in Gitxaala. _Canadian Journal of Native
Education_, 28(1 & 2), 15-32.
This article is written from the vantage point of an Indigenous scholar
located in a major research institution (UBC) about the process of
negotiating and carrying out respectful research relationships with a
First Nations community. The actual process of consultation,
accommodation, and negotiation important in establishing and growing a
respectful research relationship between the University of British
Columbia and Gitxaala Nation (north coastal British Columbia), is
described. Ethical issues and procedures, methodological innovations,
and considerations about Indigenous knowledge demonstrate transformative
action for research.
Full text available online: http://www.ecoknow.ca/journal/menzies.pdf
14. Mwachofi, A. (2007). Rural access to vocational rehabilitation
services: Minority farmers' perspective. _Disability and
Rehabilitation_, 29(11), 891-902.
Purpose. The paper documents the need for, and obstacles to effective
access to rehabilitation services by minority farmers. It draws from the
findings of a study * conducted in the Mississippi delta. Method.
Applying community-based participatory research approach (CBPR) the
study trained farmers to conduct interviews and focus group discussions.
They interviewed 1308 farmers and had 18 focus group discussions with
254 farmers. The study also interviewed 290 service providers and
conducted 8 focus group discussions with 72 State Vocational
Rehabilitation services (VR) counselors. Results. The study found an
unmet need for VR services in this population. Farmers were not aware of
VR services or how to access them and VR was not aware of farmers'
needs. Farmers felt marginalized and afraid that access to VR services
would diminish their ability to earn a living on the farm. Conclusions.
Collaboration between VR and rural organizations, agencies and with
rural people would help close the information and gaping service gap.
One-stop service centers in rural areas could improve access to
services. CBPR is an invaluable research tool especially among
marginalized people.
15. Navarro, A. M., K. P. Voetsch, et al. (2007). Charting the future of
community health promotion: Recommendations from the National Expert
Panel on Community Health Promotion. _Preventing Chronic Disease_, 4(3),
A68.
In the decades since chronic illnesses replaced infectious diseases as
the leading causes of death, public health researchers, particularly
those in the field of health promotion and chronic disease prevention,
have shifted their focus from the individual to the community in
recognition that community-level changes will foster and sustain
individual behavior change. The former emphasis on individual lifestyle
change has been broadened to include social and environmental factors,
often without increased resources. To find new ways to support community
health promotion at the national level, the National Center for Chronic
Disease Prevention and Health Promotion and the Division of Adult and
Community Health invited an external panel of experts to participate in
the National Expert Panel on Community Health Promotion. This article
highlights the process through which the expert panel developed its
eight recommendations. The recommendations include issues related to
community-based participatory research and surveillance, training and
capacity building, new approaches for health and wellness, and changes
in federal investments. They illustrate the steps needed to broaden the
traditional scope of public health and to advance a new vision for
improving community health and wellness.
16. Pinto, R. M., C. N. T. Schmidt, et al. (2007). Using principles of
community participatory research: Groundwork for a collaboration in
Brazil. _International Social Work_, 50(1), 53-65.
English This article presents a five-step model for establishing
participatory research reflecting the principles of collaboration
between researchers and community partners. Theoretical discussion is
illustrated from experience gained in the preliminary phases of an
international research project on HIV/AIDS work in Brazil. The
congruence with social work values is noted. French Cet article presente
un modele en cinque etapes d'etablissement d'une recherche
participative. Ce modele reflete des principes de collaboration entre
chercheurs et partenaires communautaires. L'experience de la phase
preparatoire d'un projet de recherche internationale en lien avec le
travail se le VIH/SIDA au Bresil en illustre les fondements theoriques.
La congruence avec le travail social est notee. Spanish Se presenta un
modelo de cinco fases para establecer investigacion participativa,
modelo que refleja los principios de colaboracion entre los
investigardores y los miembros de la comunidad. La teoria se ilustra con
la experiencia derivada de las fases preparatorias de un proyecto de
investigacion internacional sobre el VIH/SIDA en el Brasil. Se destaca
la congruencia de tal proyecto con los valores eticos del trabajo
social.
17. Rapkin, B. D., M. J. Massie, et al. (2006). Developing a partnership
model for cancer screening with community-based organizations: The
ACCESS breast cancer education and outreach project. _American Journal
of Community Psychology_, 38(3-4), 153-164.
There is growing enthusiasm for community-academic partnerships to
promote health in underserved communities. Drawing upon resources
available at a comprehensive cancer center, we developed the ACCESS
program to guide community based organizations through a flexible
program planning process. Over a three-year period, ACCESS partnered
with 67 agencies serving various medically underserved populations.
Organizations included hospitals, parishes, senior centers, harm
reduction programs, and recreational facilities. Program outcomes at the
organizational level were quantified in terms of introduction of new
cancer information, referral or screening programs, as well as
organizational capacity building. ACCESS represents a viable model for
promoting partnership to transfer behavioral health programs and adapt
interventions for new audiences. Plans to further evaluate and enhance
this model to promote cancer screening efforts are discussed. We argue
that, ultimately, formation and development of community partnerships
need to be understood as a fundamental area of practice that must be
systematically integrated into the mission of major academic medical
institutions in every area of public health.
18. Rhodes, S. D. (2007). Using Community-Based Participatory Research
to Develop a Chat Room-Based HIV Prevention Intervention for Gay Men.
_Progress in Community Health Partnerships: Research, Education, and
Action_, 1(2), 175-184.
19. Rust, G. and L. A. Cooper. (2007). How Can Practice-based Research
Contribute to the Elimination of Health Disparities? The _Journal of the
American Board of Family Medicine_ 20(2), 105-114.
Racial, ethnic, and socioeconomic disparities in health care and health
outcomes are well documented. Disparities research is evolving from
documenting these disparities, to understanding their causes and
mechanisms, and finally to conducting interventional research to reduce
or eliminate disparities. Unfortunately, few studies to date have
demonstrated substantial reductions in health outcomes disparities.
Traditional experimental models of research that test a single
intervention held constant throughout the study period may not have the
power to impact complex clusters of comorbid health disparities in
patients who receive care in underresourced primary care safety net
practice settings. New models of research will be required to test
dynamic, multidimensional interventions that triangulate on patients,
providers, and communities and are continuously improved with every
radar-sweep of feedback from rapid-cycle measurement of population
health outcomes on a community-wide basis. In this article, we review 12
promising strategies that could substantially increase the impact of
research on eliminating health disparities in America.
Full text available online: http://jabfm.org/cgi/reprint/20/2/105
20. Sikkema, K. J. (2005). HIV Prevention among Women in Low-Income
Housing Developments: Issues and Intervention Outcomes in a Place-Based
Randomized Controlled Trial. _The ANNALS of the American Academy of
Political and Social Science_, 599(1), 52-70.
The scope and urgency of the HIV epidemic requires the development and
evaluation of community-level behavior change intervention strategies. A
randomized, multisite community-level HIV prevention trial was
undertaken with women living in eighteen low-income housing developments
in five U.S. cities. In the nine experimental condition developments, an
intervention was undertaken that included identifying opinion leaders to
attend risk reduction workshops and to form Women's Health Councils to
carry out community events to reach all residents and support risk
reduction efforts. Baseline and twelve-month follow-up risk
characteristics were assessed by surveying 690 women at both time
points. In comparison to women in the control condition developments,
women in the community intervention developments reported significant
reductions in frequency of any unprotected intercourse and increases in
the percentage of condom-protected intercourse occasions.
Community-level interventions that engage women in neighborhood-based
HIV prevention activities can bring about reductions in HIV risk-related
sexual behavior.
21. Wilson, N., S. Dasho, et al. (2007). Engaging Young Adolescents in
Social Action Through Photovoice: The Youth Empowerment Strategies
(YES!) Project. _The Journal of Early Adolescence_, 27(2), 241-261.
The Youth Empowerment Strategies (YES!) project is an afterschool
empowerment program and research project for underserved early
adolescents. Central to YES! is an empowerment intervention that
provides early adolescents with opportunities for civic engagement with
other youth around issues of shared concern in their schools and
neighborhoods. This article specifically focuses on the use of
Photovoice as a promising way to engage youth in social change as they
take photos capturing strengths and issues in their environment and use
these as the basis of critical dialogue and collective action plans.
Adding to a growing body of information on using Photovoice, this
article reports how early adolescents in the YES! afterschool program
experienced the Photovoice process, moving from photography and writing
to initiate group-designed social action projects. Recommendations are
offered for others engaged in empowerment work with early adolescents.
Helena Hilario
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