Sarena D. Seifer

Community-Based Participatory Research From the Margin to the Mainstream Are Researchers Prepared?

Despite an increasing arsenal of effective treatments, there are mounting challenges in developing strategies that prevent and control cardiovascular diseases, and that can be sustained and scaled to meet the needs of those most vulnerable to their impact. Community-based participatory research (CBPR) is an approach to conducting research by equitably partnering researchers and those directly affected by and knowledgeable of the local circumstances that impact health. To inform research design, implementation and dissemination, this approach challenges academic and community partners to invest in team building, share resources, and mutually exchange ideas and expertise. CBPR has led to a deeper understanding of the myriad factors influencing health and illness, a stream of ideas and innovations, and there are expanding opportunities for funding and academic advancement. To maximize the chance that CBPR will lead to tangible, lasting health benefits for communities, researchers will need to balance rigorous research with routine adoption of its conduct in ways that respectfully, productively and equally involve local partners. If successful, lessons learned should inform policy and inspire structural changes in healthcare systems and in communities.

Service-Learning: Community-Campus Partnerships for Health Professions Education.

In 1995, the Health Professions Schools in Service to the Nation (HPSISN) program was launched under the auspices of the Pew Health Professions Commission as a national demonstration of an innovative form of community-based education called service-learning. The foundation of service-learning is a balanced partnership between communities and health professions schools and a balance between serving the community and meeting defined learning objectives. This article offers a definition of service-learning and an outline of its core concepts; it also describes how service-learning differs from traditional clinical education in the health professions. Further, the author discusses how service-learning programs may benefit students, faculty, communities, higher education institutions, and the relationships among all these stakeholders. The article concludes with brief descriptions of recommended resources for integrating service-learning into the medical school curriculum.

Community-Engaged Scholarship: Is Faculty Work in Communities a True Academic Enterprise?

Since Ernest Boyers landmark 1990 report, Scholarship Reconsidered: Priorities of the Professoriate, leaders in higher education, including academic medicine, have advocated that faculty members apply their expertise in new and creative ways in partnership with communities. Such community engagement can take many forms, including community-based teaching, research, clinical care, and service. There continues to be a gap, however, between the rhetoric of this idea and the reality of how promotion and tenure actually work in health professions schools. The Commission on Community-Engaged Scholarship in the Health Professions was established in October 2003 with funding from the W.K. Kellogg Foundation to take a leadership role in creating a more supportive culture and reward system for community-engaged faculty in the nations health professions schools. The authors prepared this article to inform the commissions deliberations and to stimulate discussion among educators in the health professions. The authors define the work that faculty engage in with communities, consider whether all work by faculty in community-based settings is actually scholarship, and propose a framework for documenting and assessing community-engaged scholarship for promotion and tenure decisions. They conclude with recommendations for change in academic health centers and health professions schools.

Clinical prevention and population health: Curriculum framework for health professions

Abstract The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services–health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title “Clinical Prevention and Population Health” has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.

Health professional faculty perspectives on community-based research: implications for policy and practice

Community-based research (CBR) has become central to the understanding and elimination of health disparities within the USA and across the globe. The authors sought to determine the perspectives of health professional faculty on the factors affecting their involvement in CBR and the extent of community participation in that research. Faculty from 18 health professional schools in the USA identified by their deans as being leaders in CBR completed a written survey. Respondents reported that between 5 - 10% of faculty in their schools were involved in CBR. Public perception of the university, familiarity with community-based organization leaders and institutional leadership were cited as the most significant factors contributing to a schools involvement in CBR. Long-term community relationships, recognition in tenure and promotion policies and access to funding were cited as factors that support faculty in conducting CBR. The authors conclude that a more significant investment of public and private funds, the development of interdisciplinary institutional structures for community partnerships and a more inclusive definition of scholarship are needed to achieve a central role for CBR in efforts to understand and eliminate health disparities.

Introduction to Special Issue: Advancing the Ethics of Community-Based Participatory Research

Increasingly communities are engaging in community-based participatory research (CBPR) to address their pressing health concerns, frequently in partnership with institutions. CBPR with its underlying values challenges us to expand the traditional framework of ethical analysis to include community-level and partnership-oriented considerations. This special issue considers ethical considerations inherent in CBPR, presents examples of how communities have created their own processes for research ethics review, and identifies challenges CBPR teams may encounter with institution-based research ethics committees. Drawing upon the special issue articles and the work conducted by Community-Campus Partnerships for Health and the Tuskegee University National Center for Bioethics in Research and Health Care, we propose an approach and a set of strategies to create a system of research ethics review that more fully accounts for individual and community-level considerations.

Applying Community-Based Participatory Research Principles and Approaches in Clinical Trials: Forging a New Model for Cancer Clinical Research

Although an estimated 20% of adult cancer patients are medically eligible for a cancer treatment clinical trial (CCT), adult trial participation in the U.S. remains under 3%.– Participation rates are even lower among ethnic and racial minorities and the medically underserved, who tend to have higher cancer mortality rates than the population as a whole.– Given persistent cancer health disparities in these populations, cancer clinical trial participation is increasingly an issue of social justice. Community-based participatory research (CBPR) approaches have been repeatedly recommended as a key strategy for increasing and diversifying cancer clinical trial participation and enhancing their relevance and quality. In 2006, Community–Campus Partnership for Health (CCPH) and the Education Network to Advance Cancer Clinical Trials (ENACCT) received funding from the Agency for Healthcare Research and Quality and the National Cancer Institute (NCI), along with industry and nonprofit partners, to develop the first set of national recommendations to employ CBPR approaches in multisite, phase III cancer clinical trials. The Communities as Partners in Cancer Clinical Trials: Changing Research, Practice and Policy final report, developed through a national advisory committee, two stakeholder meetings and a public vetting process, makes more than fifty detailed recommendations to engage communities in specific and meaningful ways throughout the cancer clinical trial process.1 The report is the first to provide specific guidance as to how and why clinical trials should involve communities affected by cancer—from trial design to implementation to dissemination of results. This paper describes the background and rationale for the initiative, the process used to develop and disseminate the report, and the challenges and opportunities for implementing the reports community-based approaches to cancer clinical research.

Mining the Challenges of CBPR for Improvements in Urban Health

The public health literature has broadly established that urban settings have complex impacts on the health and well-being of their residents.1 With large numbers of people living in close proximity in urban settings, there is increased likelihood that they will affect, positively or negatively, the health of communities that reside there.2 Low-income city residents, and in particular, persons of color, bear a disproportionate burden of chronic diseases such as asthma, HIV/AIDS, diabetes, heart conditions, and cancer.2,3 The additional convergence of social, environmental, political, economic, and structural factors exacerbate conditions that in turn, influence behaviors and circumstances resulting in poor health outcomes.1,4 With the proportion of people living in urban areas expanding worldwide,2 attention to methods that address causes of disease, and concurrently, preserve and maximize health, is as critical as ever.5

Relationships between community-based processes for research ethics review and institution-based IRBs: a national study.

Community groups are implementing research ethics review processes to determine whether and how research is conducted in their communities. We report on a survey of 109 of these community-based review processes about their relationships with institution-based research ethics boards (I-REBs). Ninety-two percent reported that studies they review were also reviewed by an I-REB. Over half characterized their relationship with I-REBs positively. Those with positive relationships were significantly more likely to communicate with the involved I-REBs. Challenges when working with I-REBs included delays, communication problems, and lack of I-REB understanding of community-based participatory research. Strengthening relationships between community-based review processes and I-REBs could ultimately enhance reviews of community-engaged research.

Measuring the costs of primary care education in the ambulatory setting.

In 1995, the authors obtained cost, operations, and educational activity data from 98 ambulatory care sites across the United States in which primary care teaching was occurring and compared those data with the corresponding data from 84 ambulatory care sites where no teaching was going on. The teaching sites in the sample were found to have 24–36% higher operating costs than the non-teaching sites. This overall difference in costs is approximately the same difference in costs earlier estimated for university teaching hospitals compared with non-teaching hospitals. These costs are shared by all involved in the ambulatory education process: sponsors, sites, and faculty. In a related finding, the authors discovered that 30–50% of all ambulatory care sites thought not to be involved in education are in fact teaching at a high level of involvement. Further research into not only the costs but the value of education in the clinical setting is encouraged. The authors also hope that the publication of this report will encourage accrediting bodies and professional organizations to improve the information available about ambulatory care training in general.