Anthony Isacco

Community-based participatory research: a review of the literature with strategies for community engagement.

Madeleine U. Shalowitz, MD, MBA,* Anthony Isacco, PhD, Nora Barquin, PhD, MSW, Elizabeth Clark-Kauffman, MHS, Patti Delger, RD, Devon Nelson, BA, Anthony Quinn, BA, Kimberly A. Wagenaar, RN, MSC Healthy People 2000 and 2010, the federal public health strategic plans, proposed to eliminate health disparities in populations grouped by social factors that negatively affect the health of mothers, infants, and children.1 In particular, infants and children from low-income and racial and ethnic minority families have higher rates of obesity and preterm birth, infant mortality (including sudden infant death syndrome), and morbidity and mortality because of asthma, when compared with infants and children from white or middle-income families.2–7 Despite a substantial investment by the federal government nearly more than 20 years of research and demonstration, aggregate statistics on children’s health in these areas show negligible improvement, indeed some problems have worsened. In an effort to reconceptualize the approach to society’s most intractable health problems, communitybased participatory research (CBPR) has emerged as a promising new direction. The CBPR is innovative because it harnesses community wisdom in an equal partnership with academic methodological rigor throughout the research process.8 The Agency for Healthcare Research and Quality, in its comprehensive evidence report of CBPR, offered one well-stated definition of CBPR as “a collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issues being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well-being through taking action, including social change.”8 The purpose of this article is to review the CBPR literature and to provide a case example of the initial strategies that we used to engage community members in an academic-community partnership using CBPR as our guiding framework. HISTORY AND LITERATURE REVIEW Historical Roots of Community-Based Participatory Research The historical roots of community-based participatory research (CBPR) can be traced by Kurt Lewin, who was a social scientist in the 1940s and who developed CBPR to use research for social action and change.9 The CBPR was also heavily influenced by the writings of Paulo Freire and has been used in Latin American, Asia, Africa, Brazil, Tanzania, and India before gaining ground in the United States.10 Other common terms for the CBPR are community-based action research or community participatory action research. The CBPR diverged from the predominant research approaches by involving people affected by a problem in developing solutions through collaborative research, planned action, along with process and outcome evaluation.11 In essence, the CBPR is not a strict methodology but an orientation to research that guides decision making and allows for the use of qualitative and quantitative methods. The CBPR framework has become more widely used in the United States and considered an ethical approach to research within the historical context of research injustices against disadvantaged communities, which have contributed to community distrust of research and hesitation to partner with researchers.12 The Tuskegee syphilis experiment represents one shocking example13 (African-American men were followed up in a study of the natural history of syphilis beginning in the 1930s. Until 1972, they remained untreated and unaware that treatment was available—even though penicillin became available in the late 1940s and the study team knew about the effective treatment). In contrast, CBPR scholars agreed that an equal partnership between researchers and communities would facilitate trust, help ensure ethical conduct, and increase the likelihood for a successful project. The CBPR is consistent with scholarship from multiculturalist theory, anthropology, feminist theory, and other fields of the study, which have introduced relational process-oriented paradigms as alternatives or complements to traditional research approaches. Traditional research approaches have emphasized knowledge creation through the collection of observable, quantifiable data that test a priori hypotheses while maintaining a distant objective relationship with the research particiFrom the Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Chicago, IL; *Northwestern University, Feinberg School of Medicine, Chicago, IL.

A Review of Men's Health and Masculinity

Mens health is a new and evolving area of specialty that goes beyond mens cancers and sexual activities. Mens health in the 21st century incorporates a broader conceptualization of health, health behaviors, and lifestyle choices. This new focus results from the fact that men continue to lag behind women in life expectancy and in health care use, a situation that is worse for minority men. Understanding how gender socialization and masculine ideology affects mens health is an important step toward providing effective care for men. In this article, the authors review these areas and then discuss each of the top actual causes of death for men: tobacco use, poor diet, alcohol use, and physical inactivity. They then discuss the important issue of steroid use among men. Throughout the review, the authors highlight racial and ethnic differences in health behaviors. Furthermore, they provide empirically supported clinical implications to assist clinicians who see men with health concerns in their practices. Finally, they offer suggestions for creating ways to include men in the health care system in hopes of improving their use.

Religion and Spirituality as Important Components of Men’s Health and Wellness An Analytic Review

Men’s health has been receiving increased attention in health care research and practice because of associated negative outcomes and men’s reluctance to seek help. Religion or religiosity, defined as involvement in an organized, structured community focused on moral code, and spirituality, defined as the subjective, mystical, and holistic interpretation of personal beliefs and behaviors, have been associated with positive health outcomes. Specifically, religion and spirituality mediate an increase in positive health outcomes and a decrease in risk factors through social and existential well-being. However, men seem to be less religious and spiritual compared with women, a potential problem as men may be missing an important pathway to health and wellness. This state-of-the-art review examines the intersections of religion, spirituality, and health and focuses on how religion and spirituality relate specifically to men’s health and health behaviors. Subsequently, 4 health problems with religious and spiritual implications are examined that have been identified in the literature as pertinent to men’s health: (a) prostate cancer screening and coping, (b) HIV/AIDS prevention and coping, (c) addictions, and (d) palliative care. Finally, suggestions are offered for clinicians to incorporate an understanding of religion and spirituality into their patient encounters.

A Review of Gay Men’s Health Challenges, Strengths, and Interventions

This article focuses on how health practitioners can better understand and intervene with gay men. Gay men’s health is situated within 3 prominent theoretical models (ie, minority stress, gender socialization, and identity development) and associated with 3 constructs (ie, internalized homonegativity, internalized homophobia, and internalized heterosexism) to contextualize gay men’s health concerns. Throughout the article, the authors draw particular attention to research that emphasizes the strengths of gay men, as this is a notable gap in the extant literature. Furthermore, HIV/AIDS is a central concern of gay men, and this article focuses on how cultural identities and factors may intersect with HIV/AIDS status among gay men and have implications for health decision making. Affirmative clinical interventions based on theory and research are presented throughout the article, which can be applied by health professionals in various settings. Given the confusion around terminology, lack of knowledge of available resources, and prevailing negative societal myths about gay men, the article provides a glossary of definitions for unclear terms, actively disputes myths that are not empirically supported, and provides a list of available resources.

An Examination of Fathers’ Mental Health Help Seeking: A Brief Report

Fathers’ mental health help seeking is an understudied area. Using participants (N = 1,989) from the Fragile Families and Child Wellbeing Study, this study hypothesized that few fathers would seek mental health services; and increases in anxiety, depression, and parental stress would predict less mental health help seeking. Only 3.2% of the participants reported seeking mental health counseling. Among the three independent variables, only depression emerged as a significant factor that predicted less mental health help-seeking behaviors in fathers. Future research and clinical efforts need to better understand the low rates of help seeking and to identify pathways that facilitate positive mental health help seeking among fathers.

Examining the Perceptions of Zimbabwean Women about the Domestic Violence Act

The purpose of this study is to qualitatively examine how Christian women from Zimbabwe perceived the effectiveness of the Domestic Violence Act in preventing and responding to domestic violence. The study also aims to understand the unique social, cultural, and religious context of the participants that affect their attitudes and beliefs about this legislation. The findings of the study are based on an analysis of qualitative interviews. The women were recruited from the Roman Catholic Church (RCC); Reformed Church in Zimbabwe (RCZ); Methodist Church in Zimbabwe (MCZ); Zimbabwe Assembly of God Africa (ZAOGA), and Apostolic Faith Mission (AFM) in the Masvingo urban area. Most of the participants expressed confidence in the Act, saying that it goes a long way in curbing domestic violence. The participants who indicated lack of confidence in the Act argued that it is contrary to the teachings of their Christian denominations. The study also revealed that lack of confidence in the Act is due to lack of knowledge about the legislation. In particular, many were unaware of the fact that physical, psychological, and emotional abuse constitutes justification for a protection order that can remain in force when a protected person is living with the perpetrator. The article discusses these findings in relation to domestic violence in other cultures and countries and recommends raising awareness of the importance of this useful piece of legislation.

How Religious Beliefs and Practices Influence the Psychological Health of Catholic Priests

Roman Catholic diocesan priests are a subgroup of men with unique religious and spiritual roles, beliefs, and practices. This qualitative study of 15 priests from the mid-Atlantic area of the United States focused on how priests’ relationship with God and promises of celibacy and obedience influenced their psychological health. Using a consensual qualitative research (CQR) design, the analysis revealed that participants described their relationship with God as central to their health and contributing to positive outcomes (e.g., sense of connection and support). The influence of their promises of celibacy and obedience were linked to both positive outcomes (e.g., decreased stress, improved relationships) and negative outcomes (e.g., internal conflict, depression/loneliness). This study highlighted the central role that priests’ relationship with God has on positive psychological health. Future research is necessary to understand how to maximize the positive effects and minimize the negative effects of priests’ promises of celibacy and obedience, which would benefit programs aimed at supporting priests’ psychological health.

Evaluation of a Leadership Program for Fraternity Men

Interventions with fraternity men have been critiqued for an exclusive aim at decreasing negative behaviors and lacking consideration of male gender role socialization. The purpose of this study was to address those noted gaps in the literature. This study conducted an objectives-based evaluation of a strength-based, gender-sensitive program aimed at teaching fraternity men leadership skills. Findings indicated that participants were satisfied with the program and the six programmatic objectives were met such as increased self-awareness of leadership strengths and weaknesses, how gender norms influence leadership development, and how to connect mens health with leadership. Participants recommended that the program be more structured and to have a Greek co-instructor. Implications for practice and future research are discussed.

College Men’s Experiences of Gender Prejudice

Despite evidence suggesting that men’s experiences of gender discrimination are increasing, there has been little research exploring the topic. This article examines college men’s (N = 145) experiences of gender prejudice and how they respond to the events. Participants most often reported experiencing a hostile or negative comment about men, and the instigators were female and friends or partners of the victim. Most participants reported that they respond by confrontation (70, 48%), followed by a non-behavioral psychological response (34, 23%), non-confrontational response (25, 17%), and not doing anything (16, 11%). Distress level significantly predicted the use of confrontational responses. Clinical and research implications are discussed.

Development and Validation of a Father Involvement in Health Measure

Father involvement has been associated with positive social, emotional, psychological, developmental, and health outcomes in a child. However, tools for measuring father involvement have not kept pace with the expanding understanding of the roles of fathers, and in the area of child health, are blunt. The purpose of this study was to develop and validate a self-report measure of father involvement in preschooler’s health, the Father Involvement in Health–Preschool (FIH-PS). In Phase 1 (item generation), 47 items were developed based on previous qualitative work and vetted through cognitive interviews with 21 fathers of children ages 3–5 years (preschool). In Phase 2 (psychometric validation), 560 fathers of 3- to 5-year-olds (n = 392 resident, n = 168 nonresident) completed the FIH-PS item bank. Participants were predominantly White (64%), had private health insurance (53%), had a mean age of 33 years, and half of them were married. Item response theory was used to determine measurement scoring. The FIH-PS Scale was reduced from a 47-item bank to a total of 20 items supporting a 4-factor scale made up of Acute Illness, General Well-Being, Emotional Health, and Role Modeling. Following exploratory (n = 280) and confirmatory factor (n = 280) analyses, the scale followed a bifactor structure, was internally consistent (Cronbach’s &agr; = .953), and discriminated among fathers with lower involvement. A sum-to-T score crosswalk table was produced to standardize the scores along a normal distribution (M = 50, SD = 10, range = 10.8–71.3). Future research and clinical applications of the FIH-PS are discussed.