Syed M. Ahmed

Community Engagement in Research: Frameworks for Education and Peer Review

Community engagement in research may enhance a communitys ability to address its own health needs and health disparities issues while ensuring that researchers understand community priorities. However, there are researchers with limited understanding of and experience with effective methods of engaging communities. Furthermore, limited guidance is available for peer-review panels on evaluating proposals for research that engages communities. The National Institutes of Health Directors Council of Public Representatives developed a community engagement framework that includes values, strategies to operationalize each value, and potential outcomes of their use, as well as a peer-review framework for evaluating research that engages communities. Use of these frameworks for educating researchers to create and sustain authentic community-academic partnerships will increase accountability and equality between the partners.

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.

Aligning the Goals of Community-Engaged Research: Why and How Academic Health Centers Can Successfully Engage With Communities to Improve Health

Community engagement (CE) and community-engaged research (CEnR) are increasingly viewed as the keystone to translational medicine and improving the health of the nation. In this article, the authors seek to assist academic health centers (AHCs) in learning how to better engage with their communities and build a CEnR agenda by suggesting five steps: defining community and identifying partners, learning the etiquette of CE, building a sustainable network of CEnR researchers, recognizing that CEnR will require the development of new methodologies, and improving translation and dissemination plans. Health disparities that lead to uneven access to and quality of care as well as high costs will persist without a CEnR agenda that finds answers to both medical and public health questions. One of the biggest barriers toward a national CEnR agenda, however, are the historical structures and processes of an AHC—including the complexities of how institutional review boards operate, accounting practices and indirect funding policies, and tenure and promotion paths. Changing institutional culture starts with the leadership and commitment of top decision makers in an institution. By aligning the motivations and goals of their researchers, clinicians, and community members into a vision of a healthier population, AHC leadership will not just improve their own institutions but also improve the health of the nation—starting with improving the health of their local communities, one community at a time.

Cultural Issues in the Primary Care of South Asians

One of the fastest growing immigrant groups in the United States is from the Indian subcontinent of South Asia. Included in this group are people from India, Sri Lanka, Bangladesh, and Pakistan. Although there is considerable heterogeneity within and between the populations of these countries, cultural similarities contribute to common challenges when South Asian immigrants are seen in primary care settings in the United States. This article describes aspects of the South Asian culture and of the acculturation process relevant to establishing rapport and providing competent biopsychosocial care to individuals and families from this region. We discuss the differing needs of recent immigrants, second-generation Americans from South Asia, and individuals temporarily in the United States for study or employment. We discuss linguistic and interpersonal style concerns in regard to the relationship between health care professionals and immigrant patients and use case material to illustrate cultural issues. We conclude with suggestions for culturally sensitive health care of South Asians.

Salud de la Mujer: Using Fotonovelas to Increase Health Literacy Among Latinas

Background: There is an identified need for health literacy strategies to be culturally sensitive and linguistically appropriate.Objectives: The goal of our community-based participatory research (CBPR) project related to health and nutrition is to demonstrate that active community involvement in the creation of health education fotonovelas that are relevant to culture, ethnicity, gender, social class, and language can increase the health literacy of women in a disadvantaged community.Methods: We recruited 12 women to take part in our pilot fotonovela intervention about healthy eating and nutrition. Pre- and post-test assessments of knowledge, attitudes, and behavior around nutrition were given at baseline and will be collected after the completion of the project.Results: We hypothesize that post-test assessments of our participants will reveal increased nutrition knowledge as well as positive changes in attitudes and behavior toward healthy eating.Conclusions: We believe that our fotonovelas will represent experiences of community members and encourage good health practices by increasing knowledge and cooperation among community members.

Development of a Church-Based Cancer Education Curriculum Using CBPR

ancer is the second leading cause of death (following heart disease) in the United States. An estimated 1.4 million cases of invasive cancer were diagnosed in the U.S. in 2005. 1 Racial and ethnic minorities constitute a disproportionate number of these cases. African Americans have both higher cancer incidence and higher rates of cancer mortality than Whites. For instance, African American men are 20% more likely than White males to be diagnosed with cancer and are 40% more likely to die, considering all cancers combined. The five year survival rate for African American women diagnosed with breast cancer is 75%, compared with 89% for White females. Differences in survival rates are due to various factors, including poverty, disparities in treatment, reduced access to medical care, and diagnosis at a later stage. 2 In general, African Americans have a decreased likelihood of surviving five years after diagnosis for all cancer types in comparison with Whites. Wisconsin cancer incidence and mortality rates mirror national patterns. From 1996 through 2000, Wisconsins average cancer mortality rate was 195.7 per 100,000 for the whole population and 271.6 per 100,000 for African Americans. The state average for cancer incidence was 454.3 per 100,000 compared with 523.5 per 100,000 for African Americans. Milwaukee County, located in southeastern Wisconsin, has the highest concentration of African Americans in the state (24.6%) and, not surprisingly, signifi - cantly higher cancer mortality and incidence rates than the state as a whole (488.7 per 100,000 compared with 218.9 per 100,000, respectively). 3

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.

Towards a unified taxonomy of health indicators: Academic health centers and communities working together to improve population health

The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public’s health and reducing health disparities, the CTSA Consortium’s Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators. The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy’s application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.

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).

Developing a community-academic health center: strategies and lessons learned

The purpose of this paper is to describe the process that Wright State University School of Medicine used to establish and build partnerships with various stakeholders in the City of Dayton, Ohio, to develop a community—academic health center. To ensure the success of this effort, it was important to identify key stakeholders in an inner city health center, and to establish effective partnerships with the stakeholders. Common goals were developed for the health center that met the expectations of all the partners. Application of the principles of Continuous Quality Improvement (CQI) led the group to define the set of common goals. The needs of the community were identified, and mechanisms to address the needs were developed using the tools of the CQI process. The programs emphasized health promotion by focusing on patient education and behavioral modification. Accepting the various priorities for the center enabled the School of Medicine to establish a quality community-based educational site for students...