Cheryl A. Maurana

Overcoming Barriers to Effective Community- Based Participatory Research in US Medical Schools

Research to improve the health of communities benefits from the involvement of community members. Accordingly, major federal and foundation funding agencies are soliciting health promotion/disease prevention programme proposals that require active community participation. However, creating such partnerships is difficult. Communities often perceive conventional research as paternalistic, irrelevant to their needs, manipulative, secretive and invasive of privacy. Many institutions and researchers view community knowledge as lacking in value. Community-based participatory research (CBPR) is a collaborative partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research process. In this article the authors consider the barriers to institutional change and faculty participation in CBPR, and propose some steps for overcoming the barriers and making CBPR an integral part of a medical institutions research agenda. Training and supporting faculty in the philosophy and methods of this approach is the cornerstone of improved community-based research.

Building Effective Community—academic Partnerships to Improve Health: A Qualitative Study of Perspectives from Communities

Purpose To identify, through a qualitative study, community perspectives on the critical factors that facilitate the development, effectiveness, and sustainability of community—academic partnerships. Method Between June 1998 and April 1999, 25 semistructured interviews were conducted with community members who represented eight partnerships at five academic health centers. Content analysis and open coding were performed on the data, and patterns of ideas and concepts were categorized. Results After review of the data, responses from three partnerships were excluded. Nine major themes that community respondents thought strongly influenced the effectiveness of community—academic partnerships emerged from respondents from the remaining five partnerships: (1) creation and nurturing of trust; (2) respect for a communitys knowledge; (3) community-defined and prioritized needs and goals; (4) mutual division of roles and responsibilities; (5) continuous flexibility, compromise, and feedback; (6) strengthening of community capacity; (7) joint and equitable allocation of resources; (8) sustainability and community ownership; and (9) insufficient funding periods. Conclusion The themes that emerged from this study of the perceptions and experiences of the community partners in community—academic partnerships can be critical to further developing and evolving these partnerships.

A successful academic-community partnership to improve the public's health.

As academic health center seek to address the changes in the health care system and in medical education, several approaches have been tried, some successfully, others not. The authors describe a successful approach that involves a close partnership between the health professions schools at two academic institutions, and agencies from the surrounding community. Specifically, the Center for Healthy Communities, begun in 1991 and formally institutionalized in 1994 in Dayton, Ohio, is a partnership among the schools of medicine, nursing, and professional psychology at Wright State University (WSU); the department of social work at WSU; the Allied Health Division of Sinclair Community College; more than 200 individuals (from grassroots neighborhood people to civic leaders); and 50 health and human services organizations in the Dayton area. The Center is recognized as a force for change in health professions education and health care delivery both in the community and in the academic settings. The authors explain how the Center was formed, list its goals (such as establishing strong partnerships among community educators and providers and educating students in the delivery of primary health care in the community), explain three principles that have been followed and that were crucial to the success of the Center (for example, individuals in the community must become empowered to capitalize on their strengths), and discuss the major difficulties that the community and the academic institutions encountered and strategies for meeting them (such as the importance of building trust and the importance of learning the needs identified by the community partners, not just those identified by the academic partners). The authors maintain that a successful community-academic partnership must be built on the foundation of community health development, a concept analogous to economic development, and that such a partnership can be a powerful tool for making a difference in the communitys health.

Working with our communities: moving from service to scholarship in the health professions.

CONTEXT As faculty at health professionals schools have become increasingly engaged with their communities in partnerships to improve health, new questions have arisen about faculty rewards for such activities. To sustain the community work of their faculty, institutions need to reconceptualize faculty rewards, promotion, and tenure that are relevant to community activities. HISTORICAL PERSPECTIVE Scholarship has evolved since the 17th century from a focus on character-building to the practical needs of the nation to an emphasis on research. In 1990, Boyer proposed four interrelated dimensions of scholarship: (1) discovery; (2) integration;(3) application; and (4) teaching. The challenge became the development of criteria and innovative and creative ways to assess community scholarship. CURRENT MODELS FOR COMMUNITY SCHOLARSHIP This paper reviews four evidence-based models to document and evaluate scholarly activities that are applicable to community scholarship. PROPOSED MODEL FOR COMMUNITY SCHOLARSHIP We propose a new model for community scholarship that focuses on both processes and outcomes, crosses the boundaries of teaching, research, and service, and reshapes and integrates them through community partnership. We hope this model will generate national discussion about community scholarship and provide thought-provoking information that will move the idea of community scholarship to its next stage of development.

A model to translate evidence-based interventions into community practice.

There is a tension between 2 alternative approaches to implementing community-based interventions. The evidence-based public health movement emphasizes the scientific basis of prevention by disseminating rigorously evaluated interventions from academic and governmental agencies to local communities. Models used by local health departments to incorporate community input into their planning, such as the community health improvement process (CHIP), emphasize community leadership in identifying health problems and developing and implementing health improvement strategies. Each approach has limitations. Modifying CHIP to formally include consideration of evidence-based interventions in both the planning and evaluation phases leads to an evidence-driven community health improvement process that can serve as a useful framework for uniting the different approaches while emphasizing community ownership, priorities, and wisdom.

Leadership in a Public Housing Community

Community Health Advocate (CHA) programs train community members to assist and advocate for other members of the community regarding health and other community issues. These programs have been successful in improving the health and quality of life of communities. We developed a CHA program in a single public housing development. This program faced unique challenges since the advocates both worked and lived in the same setting. However, confronting and resolving these issues ultimately enhanced the quality of the program.

The Merits and Challenges of Three-Year Medical School Curricula: Time for an Evidence-Based Discussion.

The debate about three-year medical school curricula has resurfaced recently, driven by rising education debt burden and a predicted physician shortage. In this Perspective, the authors call for an evidence-based discussion of the merits and challenges of three-year curricula. They examine published evidence that suggests that three-year curricula are viable, including studies on three-year curricula in (1) U.S. medical schools in the 1970s and 1980s, (2) two Canadian medical schools with more than four decades of experience with such curricula, and (3) accelerated family medicine and internal medicine programs. They also briefly describe the new three-year programs that are being implemented at eight U.S. medical schools, including their own. Finally, they offer suggestions regarding how to enhance the discussion between the proponents of and those with concerns about three-year curricula.

Strategies for Developing a Successful Community Health Advocate Program

“We want someone who looks and talks like us to help us find ways to be healthier.” This quote, from a Dayton, Ohio, community leader in 1992, led to the development of a community health advocate program with a focus on neighbors helping neighbors to improve health. This article describes advocacy

Opening the Black Box: Conceptualizing Community Engagement From 109 Community–Academic Partnership Programs

Background: This research effort includes a large scale study of 109 community–academic partnership projects funded by the Healthier Wisconsin Partnership Program (HWPP), a component of the Advancing a Healthier Wisconsin endowment at the Medical College of Wisconsin (MCW) in Milwaukee, Wisconsin. The study provides an analysis unlike other studies, which have been smaller, and/or more narrowly focused in the type of community–academic partnership projects analyzed.Objectives: To extract themes and insights for the benefit of future community–academic partnerships and the field of community-engaged research (CEnR).Methods: Content analysis of the final reports submitted by 109 community–academic partnership projects awards within the time frame of March 2005 to August 2011.Results: Thirteen themes emerged from the report analysis: community involvement, health accomplishments, capacity building, sustainability, collaboration, communication, best practices, administration, relationship building, clarity, adjustment of plan, strategic planning, and time. Data supported previous studies in the importance of some themes, and provided insights regarding how these themes are impactful.Conclusion: The case analysis revealed new insights into the characteristics of these themes, which the authors then grouped into three categories: foundational attributes of successful community–academic partnership, potential challenges of community–academic partnerships, and outcomes of community–academic partnerships. The insights gained from these reports further supports previous research extolling the benefits of community–academic partnerships and provides valuable direction for future partners, funders and evaluators in how to deal with challenges and what they can anticipate and plan for in developing and managing community–academic partnership projects.

A Social Network Analysis of 140 Community‐Academic Partnerships for Health: Examining the Healthier Wisconsin Partnership Program

Social Network Analysis (SNA) provides an important, underutilized approach to evaluating Community Academic Partnerships for Health (CAPHs). This study examines administrative data from 140 CAPHs funded by the Healthier Wisconsin Partnership Program (HWPP).