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ICR Abstracts: 5.10
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Helena
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Oct 31, 2007 13:04 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 (5.10: October 31, 2007)
1. Bell, M. (2007). Community-based parenting programmes: An exploration
of the interplay between environmental and organizational factors in a
Webster Stratton project. _British Journal of Social Work_, 37(1),
55-72.
This article describes a research study which explored ways in which the
inter-professional delivery of six parenting programmes from a community
base succeeded in including families in high and low need. The findings
suggest that working out-of-agency, with shared therapeutic purpose and
from an established theoretical base, facilitated collaboration for the
practitioners, although ongoing ownership of the programme by the
participating agencies was not engendered by the funding arrangements.
The community base promoted opportunities for a more inclusive,
participative approach which was experienced as helpful by families with
differing levels of need, suggesting that parenting programmes can be
both preventive and restorative, at least in the short term. It is
suggested that, while the new structures for the inter-agency delivery
of Children's Services proposed in the 2004 Children Act, should promote
opportunities for such programmes to be developed within mainstream
service provision, and for closer engagement with schools, parenting
programmes may not be at the core of the statutory service agenda
2. Benedict, S., M. Campbell, et al. (2007). Seeds of HOPE: A Model for
Addressing Social and Economic Determinants of Health in a Women's
Obesity Prevention Project in Two Rural Communities. _Journal of Women's
Health_, 16(8), 1117-24.
Socioeconomic status (SES) and income disparity are strong predictors of
health, and health promotion interventions that address them are more
likely to be meaningful to participants and to sustain positive effects.
Seeds of HOPE is an innovative project that is the result of a
long-standing collaboration between the University of North Carolina
(UNC) Center for Health Promotion and Disease Prevention, a Centers for
Disease Control and Prevention (CDC) Prevention Research Center, and
communities in rural North Carolina. Initial formative work, including
key informant interviews, community surveys, and focus groups,
strengthened our understanding of the link between hope and health and
the importance of addressing social and economic issues as part of our
health promotion interventions. A Seeds of HOPE strategic plan was
developed using a community-based participatory process and led to the
idea to start Threads of HOPE, an enterprise that will serve as a
business laboratory where women will produce and market a unique product
and also learn business skills. Threads of HOPE will be a
health-enhancing business and will serve as a training program for a new
cadre of women entrepreneurs in two rural communities.
3. Cooper, D. G. and S. P. Hays. (2007). Engaging Youth for Positive
Change: A Critical Analysis of Case Studies on Local Action. _Children,
Youth and Environments_ 17(2), 433-453.
This paper discusses the experiences and outcomes associated with
Engaging Youth for Positive Change (EYPC), a youth civic engagement
program developed to address clean indoor air policy, piloted in four
Illinois communities. Youth involvement in public policy offers a
potentially powerful tool for empowering youth to affect change,
especially when youth representatives are involved as partners in
identifying needs, conducting research, and making decisions. The EYPC
program seeks to 1) facilitate a critical consciousness about factors at
multiple levels that contribute to local problems; 2) facilitate a high
level of understanding about power and politics; 3) make youth
participants more effective in their efforts to advocate for a clean
indoor air policy; and 4) teach youth participants how to collect and
analyze data to further support their arguments when speaking to
government officials and community members. The paper discusses the
difficulty of reconciling a desire for deeper youth engagement with
adult-directed civic education and policy goals, addresses youth
experiences with the program, and discusses preliminary program outcomes
and lessons learned.
4. Dehaven, M. J. and N. E. Gimpel. (2007). Reaching out to those in
need: The case for community health science. _Journal of the American
Board of Family Medicine_, 20(6), 527-32.
The present health care delivery model in the United States does not
work; it perpetuates unequal access to care, favors treatment over
prevention, and contributes to persistent health disparities and lack of
insurance. The vast majority of those who suffer from preventable
diseases and health disparities, and who are at greatest risk of not
having insurance, are minorities (Native Americans, Hispanics, and
African Americans) and those of lower socioeconomic status. Because the
nation's poor are most affected by built-in inequities in the health
care system and because they have little political power, policy makers
have been able to ignore their responsibility to this group. Family
medicine leaders have an opportunity to integrate community health
science into their academic departments and throughout the specialty in
a way that might improve health care for the underserved. The specialty
could adapt existing structures to better educate and involve students,
residents, and faculty in community health. Family medicine can also
involve community practices and respond to community needs through
practice based research networks and community based participatory
research models. It may also be possible to coordinate the community
activities of family medicine organizations to be more responsive to the
health crisis of those in need. More emphasis on community health
science is consistent with family medicine's roots in social reform, and
its historical and philosophical commitment to the principle of
uninhibited access to medical care for the underserved.
5. Di Bari, M., P. K. Suggs, et al. (2007). Research partnership with
underserved African-American communities to improve the health of older
persons with disability: a pilot qualitative study. _Aging: Clinical and
Experimental Research_, 19(2), 110-8.
BACKGROUND AND AIMS: Underserved ethnic minorities are often
under-represented in clinical investigations, often in the context of
poor relationships between academic institutions and their minority
communities. The aim of this study was to investigate an
African-American community's perceptions about the barriers that hinder
participation in research studies and, more broadly, on the status of
institution/community relationships. METHODS: We conducted a pilot
qualitative study, based on semi- structured interviews of leaders of
African-American communities in Winston-Salem, North Carolina. Relevant
themes were abstracted from the interviews by a standardized iterative
process. RESULTS: Interviewees identified barriers to participation of
African- Americans in research, and suggested that existing barriers may
be overcome with an innovative model of a community/institution
relationship, which would include open communication and cooperation,
mutually beneficial programs, holistic approaches to health and disease,
participatory and balanced partnerships with communities, and the
establishment of multiethnic advisory boards. CONCLUSIONS: This study
suggests strategies that public health researchers should consider to
establish effective institution/community relationships, in order to
enhance participation of underserved ethnic minorities in research
studies, and to improve the health status of their most disabled and
demanding seniors.
6. Flicker, S., R. Travers, et al. (2007). Ethical Dilemmas in
Community-Based Participatory Research: Recommendations for
Institutional Review Boards. _Journal of Urban Health_, 84(4), 478-193.
National and international codes of research conduct have been
established in most industrialized nations to ensure greater adherence
to ethical research practices. Despite these safeguards, however,
traditional research approaches often continue to stigmatize
marginalized and vulnerable communities. Community-based participatory
research (CBPR) has evolved as an effective new research paradigm that
attempts to make research a more inclusive and democratic process by
fostering the development of partnerships between communities and
academics to address community-relevant research priorities. As such, it
attempts to redress ethical concerns that have emerged out of more
traditional paradigms. Nevertheless, new and emerging ethical dilemmas
are commonly associated with CBPR and are rarely addressed in
traditional ethical reviews. We conducted a content analysis of forms
and guidelines commonly used by institutional review boards (IRBs) in
the USA and research ethics boards (REBs) in Canada. Our intent was to
see if the forms used by boards reflected common CBPR experience. We
drew our sample from affiliated members of the US-based Association of
Schools of Public Health and from Canadian universities that offered
graduate public health training. This convenience sample
(n = 30) was garnered from programs where application forms
were available online for download between July and August, 2004.
Results show that ethical review forms and guidelines overwhelmingly
operate within a biomedical framework that rarely takes into account
common CBPR experience. They are primarily focused on the principle of
assessing risk to individuals and not to communities and continue to
perpetuate the notion that the domain of “knowledge production” is the
sole right of academic researchers. Consequently, IRBs and REBs may be
unintentionally placing communities at risk by continuing to use
procedures inappropriate or unsuitable for CBPR. IRB/REB procedures
require a new framework more suitable for CBPR, and we propose
alternative questions and procedures that may be utilized when assessing
the ethical appropriateness of CBPR.
7. Holkup, P. A., E. M. Salois, et al. (2007). Drawing on wisdom from
the past: an elder abuse intervention with tribal communities.
_Gerontologist_, 47(2), 248-54.
PURPOSE: The Family Care Conference (FCC) is an elder-focused,
family-centered, community-based intervention for the prevention and
mitigation of elder abuse. It is based on a family conference
intervention developed by the Maori people of New Zealand, who
determined that Western European ways of working with child welfare
issues were undermining such family values as the definition and meaning
of family, the importance of spirituality, the use of ritual, and the
value of noninterference. The FCC provides the opportunity for family
members to come together to discuss and develop a plan for the
well-being of their elders. DESIGN AND METHODS: Using a community-based
participatory research approach, investigators piloted and implemented
the FCC in one northwestern Native American community. The delivery of
the FCC intervention has grown from having been introduced and
facilitated by the researchers, to training community members to
facilitate the family meetings, to becoming incorporated into a Tribal
agency, which will oversee the implementation of the FCC. RESULTS: To
date, families have accepted and appreciated the FCC intervention. The
constructive approach of the FCC process helps to bring focus to
families' concerns and aligns their efforts toward positive action.
IMPLICATIONS: The strength-based FCC provides a culturally anchored and
individualized means of identifying frail Native American elders' needs
and finding solutions from family and available community resources.
8. Kim, J. C., C. H. Watts, et al. (2007). Understanding the impact of a
microfinance-based intervention on women's empowerment and the reduction
of intimate partner violence in South Africa. _American Journal of
Public Health_, 97(10), 1794-802.
OBJECTIVES: We sought to obtain evidence about the scope of women's
empowerment and the mechanisms underlying the significant reduction in
intimate partner violence documented by the Intervention With
Microfinance for AIDS and Gender Equity (IMAGE) cluster-randomized trial
in rural South Africa. METHODS: The IMAGE intervention combined a
microfinance program with participatory training on understanding HIV
infection, gender norms, domestic violence, and sexuality. Outcome
measures included past year's experience of intimate partner violence
and 9 indicators of women's empowerment. Qualitative data about changes
occurring within intimate relationships, loan groups, and the community
were also collected. RESULTS: After 2 years, the risk of past-year
physical or sexual violence by an intimate partner was reduced by more
than half (adjusted risk ratio=0.45; 95% confidence interval=0.23,
0.91). Improvements in all 9 indicators of empowerment were observed.
Reductions in violence resulted from a range of responses enabling women
to challenge the acceptability of violence, expect and receive better
treatment from partners, leave abusive relationships, and raise public
awareness about intimate partner violence. CONCLUSIONS: Our findings,
both qualitative and quantitative, indicate that economic and social
empowerment of women can contribute to reductions in intimate partner
violence.
9. London, J. K. (2007). Power and Pitfalls of Youth Participation in
Community-Based Action Research. _Children, Youth and Environments_
17(2), 406-432.
Youth-led action research can be a powerful means to inform and catalyze
community organizing and revitalization. This article presents a case
study of youth-led action research to improve educational and
recreational resources in a diverse low-income neighborhood in San
Francisco. It analyzes this case through a set of three matrices to
evaluate the quality and impacts of youth participation in action
research. The first matrix uses the dimensions of youth authority over
decision-making and youth inclusion in successive phases of the action
research to describe the scope and scale of the youth participation. The
second matrix uses the alignment of the youth participation model with
organizational capacity and community change objectives to assess the
overall quality of the youth participation. Finally, impacts on youth
participants and on community or policy change are measured to
understand effectiveness of the participation. This analysis suggests
that practitioners and scholars of participatory research carefully
consider the resources and program design necessary to support
sustainable and effective participatory action research over time. It
also points to the need for long-term commitments by funders to efforts
that engage youth in meaningful community change.
10. Mendias, E. P. and D. P. Paar. (2007). Perceptions of health and
self-care learning needs of outpatients with HIV/AIDS. _Journal of
Community Health Nursing_, 24(1), 49-64.
Health promotion increases healthy behaviors, enhances health status,
and decreases health care costs of chronically ill persons. As HIV has
become a chronic illness, many HIV-positive persons may have health
learning needs that affect their behaviors, health status, and health
care costs. Health learning needs may be general or HIV specific. Social
stigma may affect learning resource usage. We used Pender's Health
Promotion Model and community-based health promotion principles as
theoretical underpinnings for an exploratory study of perceived health
and self-care learning needs, barriers, and preferred learning
modalities of outpatients with HIV/AIDS. A nonrandom sample of 151
adults completed a researcher-designed self-report survey. Most (97%)
expressed interest in health and self-care. Many identified multiple
topics, learning barriers, and preferred learning modalities. A
statistically significant difference (p =.027) was noted in
communication needs of participants diagnosed with HIV versus AIDS.
Findings have led to practice changes, health promotion activities, and
further research.
11. Moskowitz, J. A., G. Kazinets, et al. (2007). "Health is strength":
A community health education program to improve breast and cervical
cancer screening among Korean, American Women in Alameda County,
California. _Cancer Detection & Prevention_, 31(2), 173-183.
Background: A 48-month community intervention was conducted to improve
breast and cervical cancer (BCC) screening among Korean American (KA)
women in Alameda County (AL), California. KA women in Santa Clara (SC)
County, California served as a comparison group. Methods: Random samples
of KA women from each county were surveyed by telephone in 1994(n =
818)and 2002(n = 1084). Propensity score analyses were used to estimate
the difference between counties in changes over time in screening (Pap
tests, breast self-examinations, clinical breast examinations, and
mammography), and to estimate differences in screening between
participants and non-participants in an educational workshop among women
in AL in 2002. Results: Mammography screening and clinical breast
examinations increased over time in both counties. Pap tests increased
in AL but not SC, and breast self-examinations did not change
significantly in either county. None of the intervention comparison
group differences over time were significant. In 2002, compared to
non-participants, women who attended a workshop were more likely to
report a recent Pap test (P < .08). Conclusions: Although our overall
intervention did not appear to enhance screening practices at the
community-level, attendance at a women's health workshop appears to have
increased cervical cancer screening. (C) 2007 International Society for
Preventive Oncology. Published by Elsevier Ltd. All rights reserved.
[References: 29]
12. Prell, C., K. Hubacek, et al. (2006). Using stakeholder and social
network analysis to support participatory processes. _International
Journal of Biodiversity Science and Management_, 3, 249-252
13. Reinschmidt, K. M. and J. Chong. (2007). SONRISA: a curriculum
toolbox for promotores to address mental health and diabetes.
_Preventing Chronic Disease_, 4(4), A101.
INTRODUCTION: SONRISA is a Spanish/English mental health curriculum
toolbox developed for promotores (community health workers) who work
with Hispanic clients to prevent or manage diabetes. Promotoras and
community members from a community-based project requested their
university partner to help promotores address depression observed in
their clients with diabetes. METHODS: Data collection included reviewing
existing educational materials and conducting focus groups. Promotoras
piloted the first version of SONRISA in a 1-day workshop. RESULTS: Four
curricula from community agencies were reviewed, and 49 individuals
participated in eight focus groups. Promotora feedback during the
workshop informed the revision of SONRISA. The community-based
participatory approach produced a highly relevant and culturally
appropriate toolbox for general use by promotores and their clients.
SONRISA provides training material to address depression and diabetes,
educational material for clients, and approaches to prevent work-related
emotional burnout. CONCLUSION: SONRISA offers an innovative, integrated
approach to training promotores to address depression among their
clients with chronic illnesses. It is culturally appropriate and
adaptable to other populations.
14. Savage, C. L., J. Anthony, et al. (2007). The culture of pregnancy
and infant care in African American women: An ethnographic study.
_Journal of Transcultural Nursing_, 18(3), 215-23.
In Hamilton County, Ohio, the infant mortality rate for African American
infants in 2002 was 18.1 per 1,000 live births compared with 14.4 for
the United States. It is essential to engage community residents and
leaders in identifying the underlying cultural factors contributing to
this disparity. The purpose of the study was to explore the cultural
contexts of prenatal and infant care practices among African American
women of childbearing age living in an urban community located in
Hamilton County, Ohio. This was an ethnographic community-based
participatory research study. Seven participants were recruited for the
study. Family support from mothers and sisters in obtaining needed
resources related to pregnancy and child care emerged as the central
theme. A strong family-based social network was core to the culture of
pregnancy and infant care for these women. Nurses should consider
developing family-centered interventions to reduce disparity in infant
health.
15. Smith, D. A., N. C. Edwards, et al. (2007). 'Making a difference': A
new care paradigm for pregnant and parenting Aboriginal people.
_Canadian Journal of Public Health_, 98(4), 321-5.
OBJECTIVE: To describe community-based stakeholders' views of how safe
and responsive care "makes a difference" to health and well-being for
pregnant and parenting Aboriginal people. Community-based stakeholders
included community members, providers of health and social care, and
health care and community leaders. METHODS: A postcolonial standpoint,
participatory research principles and a case-study design were used to
investigate two Aboriginal organizations' experiences improving care for
pregnant and parenting Aboriginal people. Data were collected through
researcher field notes, exploratory interviews and small group
discussions with purposively selected community-based leaders, members
and providers. Data were analyzed using an interpretive descriptive
method. RESULTS: Community participants' views of "making a difference"
emphasized: recognizing relevant outcomes of care; acknowledging
progress over time; and using a strengths-based approach in which
providers appreciate individuals' efforts and the challenges of their
contextual circumstances. DISCUSSION: "Making a difference" to pregnant
and parenting Aboriginal people would facilitate Aboriginal peoples'
efforts to tackle the deeply embedded socio-historical determinants of
well-being and capacity, and thus shift priorities for care upstream to
focus on such determinants. Such a paradigm for care would integrate
multiple perspectives on desirable outcomes within local frameworks
based on values and priorities of Aboriginal parents, while also
incorporating the benefits and wisdom of existing yet further downstream
approaches to care. CONCLUSION: Design and evaluation of care based on
community values and priorities and using a strengths-based approach can
improve early access to and relevance of care during pregnancy and
parenting for Aboriginal people.
16. Smith, K. C., F. Stillman, et al. (2007). Buying and Selling
"Loosies" in Baltimore: The Informal Exchange of Cigarettes in the
Community Context. _Journal of Urban Health_, 84(4), 494-507.
Since the release of the first Surgeon General's report, the proportion
of adult smokers in the U.S. has been reduced by half (U.S. Department
of Health and Human Services, 2004). This success has not, however, been
equally felt across all social strata. Recent survey data from Baltimore
show considerably elevated smoking rates within urban, African-American
communities. Of particular concern was that in some communities, over
half of the young adults (18-24 years old) smoke cigarettes. As yet,
there has been little focus on understanding or preventing cigarette
smoking among young adults, particularly for those seeking entry into
the workforce rather than being engaged in higher education. In this
paper, we explore community factors contributing to high young adult
smoking prevalence. Our analysis is based on data from four focus groups
conducted in 2004 as part of a community-based participatory research
project with two urban education and job training organizations. The
focus group data reflect the experiences and opinions of 28 young adult
program participants (23 smokers and 5 nonsmokers). The data highlight a
normalized practice of buying and selling single cigarettes ("loosies")
within the community, with participants describing buying loose
cigarettes as a preferred acquisition practice. We apply theories of
informal economy and suggest that this alternative purchasing option may
influence the smoking behavior of these young adults. We argue that
public health efforts need to more closely consider the impact of
community structures on program implementation. Overlooking key
community characteristics such as the availability of single cigarettes
may serve to intensify health disparities.
17. Stringer, L. C., A. J. Dougill, et al. (2006). Unpacking
“Participation” in the Adaptive Management of Social–ecological Systems:
a Critical Review. _Ecology and Society_ 11(2), 39.
Adaptive management has the potential to make environmental management
more democratic through the involvement of different stakeholders. In
this article, we examine three case studies at different scales that
followed adaptive management processes, critically reflecting upon the
role of stakeholder participation in each case. Specifically, we examine
at which stages different types of stakeholders can play key roles and
the ways that each might be involved. We show that a range of
participatory mechanisms can be employed at different stages of the
adaptive cycle, and can work together to create conditions for social
learning and favorable outcomes for diverse stakeholders. This analysis
highlights the need for greater reflection on case study research in
order to further refine participatory processes within adaptive
management. This should not only address the shortcomings and successes
of adaptive management as a form of democratic environmental governance,
but should also unpack the links between science, institutions,
knowledge, and power.
Full text available online:
http://www.ecologyandsociety.org/vol11/iss2/art39/
18. Sun, A., S. Stearman, et al. (2007). Accessing Cultural Competent
Health Education Programs in the Twenty-first Century. _Chinese America:
History & Perspectives_, 75-80.
The article offers information on the Chinese Community Health Resource
Center (CCHRC) in San Francisco, California. It is a nonprofit
organization whose mission is to promote a healthier lifestyle through
bilingual health education, programs, and services and to participate in
community-based research related to health care. Its programs include
health seminars and forums and disease management.
19. Tajik, M. and M. Minkler. (2007). Environmental justice research and
action: A case study in political economy and community-academic
collaboration. _International Quarterly of Community Health Education_,
26(3), 213-31.
Community-university partnerships increasingly are being created to
study and address environmental injustices. This article describes a
case study of one such effort and its contributions to a decade-long
community struggle to curb the growth of industrial hog operations and
their adverse health effects in the United States' rural south.
Worldwide transformation of livestock production from family farms to
large-scale industrial agricultural complexes has resulted in the
degradation of local environments, with negative impacts on public
health. In the rural south, the concentration of industrial livestock
operations has been most pronounced in low income African-American
communities. Using political economy and community-based participatory
research (CBPR) as a conceptual framework, this article explores the
partnership between a strong community-based organization, Concerned
Citizens of Tillery, and researchers at the University of North
Carolina, Chapel Hill, School of Public Health to study and address this
problem. The political, economic, and historical context of the
partnership is examined, as are the challenges faced, and the
partnership's contributions to maintaining grassroots community
organizing and activism and affecting local policy change. Implications
for other CBPR partnerships are discussed.
20. Willison, K. D., P. Williams, et al. (2007). Enhancing chronic
disease management: A review of key issues and strategies.
_Complementary Therapies in Clinical Practice_, 13(4), 232-9.
This paper highlights three selected issues and potential strategies
towards meeting chronic disease management needs. First, the orientation
of the biomedical science model often gives insufficient attention to
chronic health care needs. A second issue is that the use of
complementary and alternative medicine (CAM) may offer for some an
opportunity to enhance their chronic disease management efforts. A third
issue is that our understanding of this potential is limited, as many
who use CAM do not disclose such use. With reference to proposed
solutions/strategies, first, an improved focus to respect patient/client
values and goals may encourage people to disclose their use of CAM.
Second, a community-based participatory approach shows promise in
enhancing communication plus helps integrate CAM within new models of
chronic disease management. Lastly, those in public health could help
facilitate such an approach plus be a monitor of CAM practices. Overall,
this review provides a springboard for further research and practice in
CAM and the management of chronic diseases.
Helena Hilario
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